Mandatory Reporting and Duty to Warn

Federal, state, and tribal laws mandate that providers report to appropriate authorities when they suspect any of the following:

• A child is being or has been abused or neglected.
• A vulnerable adult (including elders) is being or has been abused or neglected.
• Someone is at imminent risk of self-harm or harming others.

Many human services providers are mandated reporters, including mental health counselors, physicians, nurses, social workers, psychiatrists, psychologists, health aides, teachers, police, magistrates, and others in law enforcement. Mandated reporters are required to make "reports of harm" or "reports of concern" to the appropriate authorities. See Alaska Statute 47.17.020 and federal laws 18 U.S.C. § 1169 and 25 U.S.C. § 3203 for more information on Persons Required to Report.

As a behavioral health provider, you are a mandated reporter. This means that whenever you have reasonable cause to suspect abuse or neglect of a child or vulnerable adult or that a client is at imminent risk of self-harm or harming others, you must report it even if you believe others have already made reports. Failure to report suspected abuse or neglect within 24 hours is a Class A Misdemeanor. You can be arrested and jailed for choosing not to report. Even if you hear about abuse or neglect when you are off the clock and on your own time, you are still required to report.

It is not your job to investigate or confirm the suspected abuse or neglect. The Alaska State Troopers, OCS, and APS have specific procedures to investigate reports, and when clinicians or providers try to investigate, it can compromise the case. You do not have to investigate the truthfulness of the report.

When you suspect abuse is occurring, submit a "report of harm" by calling OCS/APS, faxing a completed report of harm form, or submitting your report online to APS or online to OCS. It will be screened by an OCS/APS intake worker, who may initiate an investigation. If an investigation is initiated, there will be findings of either substantiated or unsubstantiated abuse. OCS/APS may continue to work with the family in either case.

If OCS/APS opens a case, you may work in partnership with Indian Child Welfare Act (ICWA) workers and OCS/APS, who can help provide support to the client and family. Victims or perpetrators and their families may also need services outside the community. Consider and work to identify resources for their aftercare and plans for local resources and support.

Remember that some clients will choose to share information only after requesting referrals for services outside the community; often, this is because they are uncomfortable talking about such private or sensitive information with people they know, including you.

Reporting suspected abuse can be hard on everyone, including behavioral health workers. It can be especially difficult to be the mandated reporter in a small, close-knit community. Making reports of suspected abuse against children and elders is often discouraging. When you are faced with these situations, it is important to remember:

• Abuse victims often experience behavioral health problems from unreported and unaddressed abuse.
• Reporting abuse can also lead to healing.
• In addition to supporting your clients, you need to practice self care.

Always tell new clients the limits of confidentiality.

• The limits of confidentiality should be explained as early as possible when working with clients. Explain that you are a mandatory reporter and that you are required to report on matters of child and vulnerable adult abuses.
• Sometimes, you learn about possible abuse in your first encounter with the client. In other cases, you won't become aware of the abuse until after you've met with the client multiple times. Regardless of when you learn of the possible abuse or neglect, if clients share reportable information with you, remind them that you are mandated to report cases of abuse or neglect. It can be helpful to speak with your supervisor and practice ways to have this conversation with your clients.

Talk with your supervisor whenever you have suspicions of abuse or neglect of a child or vulnerable adult.

• In an emergency situation, report first to OCS/APS and/or the Alaska State Troopers (AST), then consult your supervisor. In situations like these, make the telephonic report to a person, do not leave a voice message, and do your best to keep the client in a safe location (like the clinic or office) while you make emergency reports.
  Note: Emergency situations include active abuse occurring or if the client will be leaving your office and entering an actively abusive environment. In other words, they are currently in harm's way or will immediately be put in harm's way when they leave.
• In a non-emergency situation, consult your supervisor before calling OCS/APS.
  Note: You do NOT need a Release of Information (ROI) to communicate with OCS/APS or the AST when you are acting as a mandated reporter.

Reports should be made to OCS/APS. For Alaska Native children, you should also communicate with the tribal ICWA worker if you have a valid ROI.

• Know your THO's policies and procedures for mandated reporting.
• Talking with your supervisor does not remove your responsibility to report to OCS/APS. You and your supervisor can determine the best course of action for reporting. However, if the report is not made, you will be the one held accountable, as you were the firsthand recipient of the information provided by your client.
• You can ask that your report be marked as an “anonymous report from a mandatory reporter” if you think it is necessary for your and your family's safety and protection.

Act quickly. The report must be made as soon as reasonably possible and within 24 hours for vulnerable persons and abused or neglected children. Report by the best means possible (phone or in person) as long as OCS/APS will receive it quickly or immediately. If you submit a report of harm by fax, by email, or online, it is best practice to call the OCS/APS intake line to confirm it was received.

If immediate action is necessary for the wellbeing of the child and if you cannot reach OCS in a timely manner, report to a law enforcement officer, who can take appropriate action to protect the child.

Document all reports of suspected abuse. Follow your organizational procedures for documenting reports of suspected abuse.

Some situations do not require you to make a report:

• If the child or adult already has an open case with OCS/APS, contact the assigned case worker to provide additional information. If you cannot reach the assigned case manager and there is an emergency, contact the main OCS/APS intake office.
• If your supervisor has decided to submit a report of harm on your behalf based on information that you shared with them, you do not need to submit a second report of harm.

If the client makes a credible threat to put someone in immediate danger of serious harm, you have aduty (obligation) to warn the intended target.

• If the immediate danger is foreseeable and is to a specific person, you must take reasonable steps to contact and warn that person. If you cannot reach that person, you must contact law enforcement to notify them of the threat.
• Always contact law enforcement if the danger is not limited to a specific person. For example, contact law enforcement if your client said he is going to get a gun and shoot the first person he sees at the store.
• Use deescalation techniques to keep yourself and others safe. Creating a safe work environment will also support safety in dangerous situations.

Sometimes people say things they don’t mean when they are angry. Only report a threat when:

• It is real.
• It involves immediate action or danger.
• It would result in serious and foreseeable harm.
• The client has access and means to carry out the threat.

Risk factors to consider when deciding if a threat is real:

• The client has named a victim or victims.
• The client has a history of violence (e.g., has a history of assault with weapons or making bullying threats).
• There are other factors indicating that the client may be at risk to cause harm to others (e.g., is intoxicated, has had changes in normal behavior, and/or hears voices saying to hurt others).
• There is a real possibility that the client can follow through and act successfully on the threat (e.g., threatened to shoot somebody and has access to a gun).
• The client has access to weapons.
• The client has experienced recent losses (e.g., is homeless or jobless or has recently ended a relationship).
• Your gut feeling tells you the threat is real.

When warning others, share only the minimum necessary amount of information to protect others from harm. The rest of the information is still confidential. For example:

• DO tell the police that your client is mentally unstable, has threatened to shoot people at the store, and just left your office two minutes ago.
• DO NOT go into details about your client's reasons for getting treatment, personal history, secrets, etc.

Unless there is an immediate emergency, talk with your clinical supervisor before sharing any confidential information with others.

Document. Any time you warn someone of danger, always document:

• The date, time, and person contacted.
• What exactly you told them.
• Why you thought there was an immediate and credible threat of serious harm.

Work as a team. If you need to fulfill your duty to warn, you should notify certain people and work as a team. At minimum, you will need to contact:

• Your supervisor.
• The intended victim.
• Law enforcement: the Village Public Safety Officer, Alaska State Troopers, or local police department.

Sometimes, you may need alternative safety support, such as a Community Health Aide/Practitioner (CHA/P) or city/tribal council member.

Many of the client threats you receive will be reported secondhand (i.e., through others in the community). You may hear from people in the village who are scared, threatened, or concerned about others.

• You are not legally required to warn others if the threat is secondhand.
• Consult with your clinical supervisor about whether you should warn others when you get the information secondhand.

Immediately report to your supervisor any serious or unusual event that has threatened or could threaten the health, safety, or welfare of you, your clients, your staff and community. Examples of events that should be reported:

• Suicide or attempted suicide.
• Deaths.
• Accidents involving clients or injuries to clients.
• Suspected abuse, neglect, or exploitation of a client.
• Activities that place the client at risk of harm or cause unusual pain.
• Onsite incidents of physical harm between a client and staff member.
• Fire, flood, or other natural disasters that damage the facility or pose health hazards to humans.
• Outbreaks of contagious diseases dangerous to public health (such as tuberculosis or Hepatitis A), incidents of food poisoning, or other environmental dangers.
• Possible physical or mental impairment of yourself or another staff member (such as someone being under the influence of drugs or alcohol while working with clients).
• A client not taking her medication or experiencing complications related to treatment. The client may also need a medical referral.