TABLE OF CONTENTS
1.0 Declaration of Principles ..............................................................1
2.0 Purpose for Domestic ViolenceTreatment Standards.............4
3.0 Definition of Domestic Violence..............................................5
4.0 Standards of Care and Treatment Providers..............................8
5.0 Education and Training Requirements.......................................12
6.0 Treatment Approaches.................................................................14
7.0 Treatment Standards......................................................................15
8.0 Discharge Criteria........................................................................18
1. Definition Section ..........................................................................19
11. Safety and Protection Plan...........................................................21
III. Control Plan.................................................................................23
IV. Client Contract.............................................................................25
V. Intake Evaluation .........................................................................26
VI. Treatment Evaluation and Monitoring Committee.....................36
VII. Power and Control Wheel................................................................38
VII. Equality Wheel................................................................................39
IX. Exceptions to the Privilege ofConfidential Communication........40
Nevada Revised Statutes Relevant to Domestic Violence
Application for Certification
Guidelines for Certification
The treatment of domestic violence offenders in the State of Nevada employs a variety of theories, modalities and techniques. Domestic violence perpetrators are a separate category of violent offenders requiring a specialized approach. The goal is victim safety through cessation of violence.
To this end, the committee and these STANDARDS subscribe to the following principles:
1.1 Violence can never be condoned under any circumstances. All behavior, whether intentional or unintentional has consequences and is the sole responsibility of the actor. Perpetrators of domestic violence must learn that engaging in violent behavior has consequences, such as arrest, suspended sentence or probation. The most prevalent causes of domestic violence include the following:
a) The reality of a patriarchal cultural value system that imbues perpetrators with a belief of entitlement based on the status of their gender. For many male perpetrators, the entitlement principle is most graphically stated as: "The bottom line is, I have the right to use brute force to get what I want in this relationship, and I will use it."
b) The perpetrator's immediate community of peers is also a causal factor in supporting the use of violent and abusive acts against a partner, primarily against women. Either by their peers' acts of omission, such as keeping the code of silence, or by acts of commission, such as agreeing violence was right, perpetrators may find implicit or explicit support for their violence.
c) The family from which the individual perpetrator originated is a causal factor. A history of father's abuse of mother or violence in the family of origin places an individual man at greater risk to use violence and abuse against his partner.
d) The individual perpetrator's inner psychological make-up and symbolic world is a fourth causal factor, albeit of less significance than the preceding three for most perpetrators. Nonetheless, an understanding of this inner world is related to understand that individual's use of violent and abusive acts against a partner.
e) Finally, the fifth causal factor of environmental stressors include specific situations and events that can increase the risk of the individual becoming a perpetrator when combinations of the first four factors are present. These include stressors of unemployment, poverty, underemployment, job threatening situations, use or abuse of alcohol and/or other drugs, and other environmental stressors that significantly increase threats to the individual's ability to effectively cope with daily life tasks in a relationship with a partner. The multiple causes of domestic violence remain underpinned by the entitlement belief that use of brute force is an acceptable, permissible action to maintain power and to take control in a conflict situation. Change of such violent and abusive actions requires accountably for these actions to authorities and responsibility for one's own behavior. One step in accountability and responsibility is the payment for the treatment program. Payment for one's own treatment is an indicator of responsibility and is a requirement of the STANDARDS.
1.2 The plight, right and individual differences of the victims must be respected.
Victims of domestic violence undergo tremendous turmoil and fear as a result of the violence inflicted. Their feelings and their potential for suffering further harm must always be of utmost consideration. Coordination between the perpetrator's and victim's therapists is highly recommended within the laws of confidence And all information concerning a victim's address or any other identifying information shall be confidential
1.3 Rights of the perpetrators must be respected.
Programs will specify treatment modalities used with perpetrators.
1.4 Treatment providers must design and implement appropriate treatment programs.
The Creation of appropriate programs requires a basic understanding of domestic violence dynamics, methods of intervention and proper and safe alternatives to violence. Providers must be equipped to perform their stated services and not misrepresent their capabilities. Any treatment provider who covertly or overtly blames the victim or in any way places the victim in a position of danger is in violation of the principles of these STANDARDS. As research on domestic violence perpetrators progresses, philosophical and programmatic changes may be necessary to implement more effective program-..
1.5 Treatment providers must cooperate and communicate with other interrelated agencies such as law enforcement, the courts, probation, victim advocates, battered women's shelters, district and city attorneys' offices.
Treatment of the offender is one element of a comprehensive community based intervention, which includes the criminal justice system's actions. Treatment can occur once domestic violence is reported. Continued interagency communication and cooperation is essential to assess the lethality of the violent offender, the potential for harm to the victim and the effectiveness of the programs. Effectiveness is to be measured by reduced recidivism (i.e. lower rates of recurring acts of violence and abuse). The Treatment Standards committee encourages the development of a coordinated community response to strength program development and delivery of service.
1.6 Treatment providers can contribute to heightened public awareness of the seriousness of domestic violence.
Traditionally, domestic violence was regarded as a private family matter not requiring intervention. Only within the last 10 years has the criminal justice system recognized the gravity of this behavior and finally elevated it to criminal status. Public awareness may require an active role on the treatment provider's part to disseminate this information.
1.7 Treatment providers must maintain individual standards that reflect professionalism
It is important to maintain a personal integrity that is consistent with professional standards. For example, in matters of personal conduct regarding this issue, providers must and will uphold non-violent actions in their own lives in their relationships with their partners.
1.8 Local and state authorities must undergo continuous review and revision consistent with treatment programs' experiences, new knowledge from outcome research demonstrating what approaches are more effective and new theoretical understanding of the causes and the intervention.
The TREATMENT STANDARDS, EVA.LUATION AND MONITORING COMMITTEE is committed to meeting at least six times per year. Review and updating of the standards will be conducted once every two years at a minimum.
1.9 The committee recognizes the fact that culturally diverse populations have unique treatment needs.
All treatment agencies should strive to service culturally diverse populations. It is beneficial for staff composition to reflect the cultural and linguistic diversity of the community they serve.
The Nevada Treatment Standards for Domestic Violence perpetrators was created to assure the following:
2.1 The purpose of treatment standards is to enhance victim safety by eliminating all forms of domestic violence.
2.2 Treatment standards provide a uniform means of reducing or eliminating violence, reflect concerns of the people of Nevada as adopted by the committee, and, as adopted and used by the County's Probation Department, Judges, District Attorney's and City Attorney's Domestic Violence Prosecution units.
2.3 Treatment standards provide recognition of current, appropriate intervention methods that provide the public with expectations of service.
2.4 Treatment standards help establish a level of responsibilities and service expected from treatment providers, which allow the TREATMENT STANDARDS EVALUATION AND MONITORING COMMITTEE to evaluate programs and provide a basis for future program development.
2.5 Treatment standards help ensure that defendants will receive appropriate therapy that is compassionate, humane and consistent.
2.6 Treatment standards mandate that only the highest level of professions will be accepted, thereby encouraging individual and program responsibility in reaching these STANDARDS.
2.7 Treatment standards will enhance the publicís awareness of issues involved in domestic violence, give victims and perpetrators increased access to treatment and reinforce the concept that violent behavior is unacceptable.
2.8 Treatment standards will provide stimulation for research. The assimilation of research results will help improve treatment methods.
2.9 Treatment standards acknowledge that treatment programs, in combination with criminal justice interventions, and other appropriate interventions such as shelters, are an acceptable method of reducing violence and are sanctioned by NRS 33.100, NRS 125.560, NRS 17 1. ("Order him to participate in and complete a program of professional counseling, at his own expense, if such counseling is available.")
2.10 Treatment standards encourage statewide communication and interaction among treatment providers.
For the purpose of this manual, domestic violence is as defined by NRS 33.018, NRS 171.1225, Sect. 2. That is, "act of domestic violence" means any acts committed by a person against another, his spouse, former spouse, any other person to whom he is related by blood or marriage, a person with whom he is or was actually residing or, a person with whom he has had or is having a dating residing, a person with whom he has a child in common, or upon the minor child of any of those persons or his minor child."
" 'Dating relationship' means frequent, infinite associations primarily characterized by the expectation of affectional or sexual involvement. The term does not include a casual relationship or an ordinary association between persons in a business or social content."
3.1 Battery and Spouse Abuse, TPO'S, Extended Orders and ETPOís: See NRS 3'3.017-33. 100; NRS 125.560, NRS 171.1225, NRS 171.137, NRS 200.571-200.601 (Appendices 7-1 1)
3.2 The following expanded definition of domestic violence are included as a broader reference, a guide for treatment providers, and for protective order purposes.
1) Physical violence: aggressive behavior including but not limited to hitting, pushing, choking, scratching, pinching, biting, restraining, slapping, pulling, hitting with weapons or objects, shooting, stabbing and damaging property or pets.
2) Sexual violence: use of physical force to make someone perform any sexual act against one's will
3) Psychological violence: using the power gained through physical and sexual violence to control the actions and behavior of another person through the following types of abusive actions:
a) threatening any and all forms of physical violence or sexual violence;
b) other threats to take away the person's livelihood, take the children, commit suicide or homicide or harm the person emotionally;
C) acts of intimidation to put the person in fear such as looks, gestures, loud voices, smashing something or destroying property or animals;
d) isolating the p by controlling what they do, who they see and talk to, and where they go;
e) emotionally abusing the person by putting them down, attacking self-esteem, calling them names, causing them to question their sanity and other mind games;
f) economically abusing the other by trying to keep them from getting a job, preventing them from looking or causing them to lose current jobs, making them ask for money, giving them an allowance and taking their money;
g) sexual abuse other than outright forced sexual acts and rape including verbal attacks on the sexual parts of the person's body and treating them like a sex object; manipulation or intimidation of the victim that forces them into sexual activity immediately following a battering episode.
h) using the children to make the other feel guilty about the children by attacking their parenting, using the children to give messages, using visitation as a way to harass the other parent, interrogating the children to accomplish surveillance of the other's life and actions; using threat to deport victim as way of separating victim from children; and using threat to kidnap and hold children hostage in a foreign country."
i) The use of male privilege to claim entitlement of a superior status, thus treating his partner like a servant making all the big decisions and acting like the king of the castle, and
j) additional forms of abusive actions, although not enumerated here, in the context of physical, psychological and sexual violence.
Defining domestic violence in greater detail as above alerts the treatment providers to attend to all forms of such violent and abusive behavior by perpetrators.
3.3 In addition to the above definitions, it should be noted that domestic violence perpetrators typically exhibit one or more of the following characteristics:
1) Little or no concern for the consequences of their behavior;
2) Little or no empathy for their victims; Increased power and control over the victims;
4) A pattern of recurrent violent and abusive behavior which tends to escalate in frequency and severity in many cases. In other cases, it may stabilize at a set level of violent and abusive acts.
5) Denial, manipulations.
6) Rationalization and projection.
The STANDARDS are written as a guideline for intervention with clients who commit acts of violence that involve individuals in intimate relationships; related by blood or marriage, living together or having lived together, having a child in common, were or are in a dating relationship, including teenage dating. They do not include acts of family violence such as child abuse or elder abuse.
4.1 Treatment providers and agencies working with perpetrators of domestic violence must meet standards outlined by professional groups with which they are affiliated, e.g., the American Psychological Association, National Association of Social Workers, American Medical Association, the American Psychiatric Association, American Association of Pastoral Counselors, the Association of Marriage and Family Therapists and Bureau of Alcohol and Drug Abuse.
4.2 In addition, treatment providers must maintain the following standards:
4.2.1 Be violence-free in their own lives.
4.2.2. Be free of criminal convictions involving moral turpitude, specifically sex offenses and capital crimes. This does not necessarily exclude former batterers in recovery programs.
4.2.3. Not communicate or act in ways that perpetuate attitudes of sexism racism or victim-blamming.
4.2.4. Not abuse drugs or alcohol
4.2.5. Immediately report any additional violence or threats of violence perpetrated by any client involved in court ordered treatment to the appropriate authorities in the criminal justice system Client signed authorizations for permission to release information for such reporting must be obtained by the provider as a condition of treatment.
4.2.6. Immediately report any suspected child abuse or neglect by a client, pursuant to Nevada Revised Statute (NRS) 432B.220. The report must be made within 24 hours and may be made verbally or in writing pursuant to NRS 432B.230.
4.2.7. Maintain open communication with the agencies involved by discussing disagreements, problems and issues related to treatment, intervention and management of cases.
4.2.8. Warn the victim if they believe that the victim is at risk per existing legal precedents including the Tarasoff ruling.
4.3 Violations of these stated ethical standards will be reported to the Treatment Standards Evaluation and Monitoring Committee, whose members will then take appropriate actions.
4.4 A treatment provider shall not discuss, without the written consent of the client, any confidential communications made by the client to the treatment provider during the course of treatment; nor shall a treatment program employee or associate, whether clerical or professions disclose any confidential information acquired through that individual's work capacity; nor shall any individual who has participated in therapy conducted under the supervision of a treatment provider, including, but not limited to, group treatment sessions, disclose any knowledge gained during the course of such therapy without the consent of the person to whom the knowledge relates. Treatment providers have the duty to warn potential victims of imminent danger if the treatment provider believes that the victim may be at risk from a client because of threats made or behaviors exhibited.
All programs shall develop a policy regarding the program's confidentiality and notify all participants, observers of direct services, and those with access to client records of this policy. They shall sign a written agreement of confidence and that agreement shall be kept on file for four years.
Programs shall inform batterers of the following limits to the program's confidentiality:
1 . Batterers are required to sign a Consent for Release of information, which permits information to be released to the victim/partner and/or her designated representative, law enforcement, the courts and any others in accordance with agency policy.
2. Where the staff determines that there is probability of imminent physical injury to the batterer himself or to others, staff will take safety initiatives and notify the person at risk.
3. Case records may be subject to subpoena.
Program shall assess for possible incidents of child abuse or neglect by the batterer. If the intake evaluation or subsequent contract reveals the possibility of actual incidents of child abuse or neglect, or abuse of the elderly or disabled, it must be reported to the Child Protective Services (CPS).
Any information given by the victim/partner, including verification of progress or continued abuse, shall not be disclosed to the batterer without documentation of the victimís oral or written permission.
If a new offense has occurred, the victim/partner should be advised of resources available from the
appropriate law enforcement agency and the local domestic violence program.
These prohibitions shall not apply when a client makes indications that they may be dangerous to the lives of others or when:
1) A client or the heirs, executors or administrators of an estate of a client file suit or a complaint against a treatment provider arising out of or connected with, the care or treatment of such client by the treatment provider.
2) A treatment provider was in consultation with a physical or mental health professional against whom a suit or compliant was filed based on the case out of which the suit or complaint arises:
3) Due to litigation by the client, a review of services of a treatment provider is conducted by a board appointed by the governing licensing agency or its investigative agents; and
4) an exception to privileged confidential communication is in effect as defined in sections 1017, 1018, 1020, 1024. (Please see Appendix XII).
4.5 A coordinated community response is necessary to assure accountability of the perpetrator. What this means is that the training, policies and operations of all local criminal justice agencies are linked closely with human service providers. Thus, treatment programs shall not exist in isolation. They shall maintain cooperative working relationships with battered women's shelters, other service providers and criminal justice programs.
4.6 If a victim of a domestic violence perpetrator is also attending counseling, with reunification, return of children to home or shared custody as a goal providers shall consider any relevant information regarding that victimís progress provided by the victim's therapist as it relates to the domestic violence perpetrators.
4.7 Treatment providers must provide a response plan for clients in crisis within the client contract.
4.8 Treatment providers must provide admission to therapy within two weeks of contact by the client. If this condition cannot be met on the pan of the program or the therapist, the treatment provider will be required to refer the client back to the original referral source and notify the referral source by telephone or in writing.
4.9 Treatment providers must report any lack of response by a client to the referring agent one week following the initial referral. The treatment provider must also make a verbal report to the referral source following each absence or missed appointment. A written report is required following two absences.
4.10 All treatment providers shall accept clients regardless of their ability to pay fees. Fees shall be collected on a sliding scale, enabling clients to afford treatment. Referral of indigent clients shall be made to all certified treatment programs following the formula of a minimum of one per cent to each program
4.11 Treatment providers must provide information about referral services for emergency calls and walk-ins.
4.12 Treatment providers shall document, in writing, all violations of the client contract. If termination is effected, this documentation shall be provided to the proper referring agent.
All treatment providers of domestic violence clients must meet the following criteria:
5.lA A person may be employed as a supervisor of treatment at a program that is certified by the committee before November 1, 1999, if he:
(1) Possesses a master's or doctorate degree in a field of clinical human services from an accredited university or college;
(2) Has satisfactorily completed at least 60 hours of formal training in domestic violence which includes at least 30 hours of training in providing services to victims of domestic violence and at least 30 hours of training in providing treatment for persons who commit domestic violence;
(3) Has never been convicted of a crime involving moral turpitude;
(4) Is free of violence in his own life; and
(5) Is not currently an abuser of drugs or alcohol
5.lB A person may be employed as a supervisor of treatment at a program that is certified on or after November 1, 1999, if he:
(1) Is licensed in good standing in the State of Nevada in psychology pursuant to Chapter 641 of NRS, marriage and family therapy pursuant to Chapter 641A of NRS or clinical social work pursuant to Chapter 641B of NRS, or is licensed in good standing to practice medicine pursuant to Chapter 63 0 of NRS and practices psychiatry;
(2) Possesses a master's or doctorate degree in a field of clinical human services from an accredited university or college.
Has satig6ctorily completed at least 60 hours of formal training in domestic violence which includes at least 30 hours of training in providing services to victims of domestic violence and at least 30 hours of training in providing treatment for persons who commit domestic violence;
(4) Has never been convicted of a crime involving moral turpitude;
(5) Is free of violence in his own life; and
(6) Is not currently an abuser of drugs or alcohol.
5.2 A person may be employed at a program as a provider of treatment in a position other than supervisor if he:
(1) Possesses a bachelor's degree or more advanced degree in a field of human resources from an accredited college or university;
(2) Is supervised by a supervisor of treatment who is qualified pursuant to 5. 1A or 5. IB and such supervision includes, without Nations meeting with the supervisor in person at least once a month and having the supervisor submit annual reports of satisfactory performance to the committee;
(3) Has satisfactorily completed at least 60 hours of in-service training in domestic violence, including at least 30 hours of training in providing services and treatment to victims of domestic violence;
(4) On or after July 1, 1998, has satisfactorily completed at least 60 hours of approved formal g in domestic violence, in addition to the training required in paragraph (3) of 5.2.
(5) Has never been convicted of a crime involving moral turpitude.
(6) Is free of violence in his own life; and
(7) Is not currently an abuser of drugs or alcohol
5.3 All treatment providers must participate in 15 hours of approved continuing education yearly. The content of the training must be relevant to the problem of domestic violence such as: current practice and research on the issue- gender analysis of the problem; sex role socialization as related to domestic violence; and cross cultural issues as related to the problem. The verification and approval of the continuing education and training will be carried out by the TREATMENT EVALUATION AND MONITORING COMMITTEE.
5.4 In counties whose populations are less than 50,000, a provider may apply for a waiver NRS 233B.066, Sections 7 (a) (a), (2) (a), (2) (b) or (3) (a) if he can demonstrate to the satisfaction of the committee that:
(1) Only one provider of batterers' treatment is located within a fifty mile radius or within the city or county where they are located;
(2) He possesses the necessary skills and training to meet the standards of treatment; and
(3) All other requirements are otherwise met.
6.0 Group Treatment
Group treatment is the intervention of choice for domestic violence perpetrators. Male/female co-therapist teams are required. Treatment providers, through their respective agencies, may decide whether groups will be open (accepting new members are an ongoing basis) or closed structure. The groups may range from a minimum of six to a minimum of 16 clients in any particular group. The individuals who are inappropriate for group treatment, such as a person who is actively psychotic in their behavior, may be provided individual treatment for their domestic violence behavior, accompanied by medical and psychiatric care for their psychosis.
6.2 Substance Abuse
When the initial intake evaluation indicates drug and/or alcohol abuse, this issue should be addressed at the onset of treatment. Referrals to other agencies for specialized treatment may be initiated in those treating the substance abuse problems. (Violence cannot be successfully addressed without treating-the substance abuse problems.) Treatment for substance abuse may not be subsumed for a client's treatment for domestic violence behavior.
6.3 Inappropriate Treatment
Any treatment approach or practice that blames or intimidates the victim or places the victim in a position of danger is not acceptable. Treatment techniques that have been shown to increase the risk and danger to the victim such as ventilation, punching pillows, hitting with batakas and other endangering approaches are unacceptable.
6.4 Couple's Therapy vs. A Couple's Session
It is not acceptable to begin domestic violence treatment utilizing traditional couples or family therapy. The perpetrator's violent behavior should first be addressed before utilizing couples/family counseling, and then only if the victim states she feels safe. These modalities may be used after the criteria identified in Section 7.2 are met. A couple's session (as opposed to ongoing couple therapy) may be used to elicit information, arrange a separation, arrange visitation for children, or to teach anger management skills such as time-out. This modality should be used only after ranking plans to ensure the safety of the victim.
7.1 At intake, each client will be evaluated individually; the evaluation will include the following:
7.1.1 A profile of the client's violent behavior which should include independent descriptions from criminal justice agencies, victims and other treatment providers. Clients will be to submit a copy of the arrest report, the court order, and the probation report; in addition, the psychological evaluation, if one has been completed.
7.1.2. A mental status examination and clinical impressions, if deemed appropriate.
7.1.3. An assessment of the client's potential for harm to self and others.
7.1.4. Medical health history, if deemed appropriate.
7.1.5. A description of substance abuse and its impact on the abuser and family system.
7.1.6. Social/psychological/cultural history.
7.1.7. A treatment plan which addresses domestic violence, child abuse, sexual abuse, alcohol and/or controlled substance abuse, and the presence or absence of psychosis.
7.1.8. A client contract which specifies the responsibilities of the treatment provider and the perpetrator. Client contracts must clearly specify that following Intake Evaluation and during the client's time in the treatment program, threats to harm or kill the victim (per the Tarasoff ruling) and/or, acts of child abuse or neglect will be reported to the appropriate legal agencies; and, that potential victims will be warned.
7.1.9. Clients will be informed that if their partners are in a battered women's shelter and if the perpetrator violates that facility, they will be dropped from the program and the court will be notified.
7.2. The minimum length of treatment is six (6) months (NRS 5.055) for the first offense. The group sessions will be a minimum of one and one half (I 1/2) hours per session. For the limited number of clients inappropriate for groups who are treated with individual treatment, the same criteria of six (6) months will apply. The individual sessions will be a minimum of fifty (50) minutes, the traditional treatment hour.
7.3. Intervention Standards. The following elements must be included in the treatment of domestic violence perpetrators:
7.3.1. All treatment providers should have the knowledge and capability to develop and provide a safety plan for a victim as appropriate. All information concerning a victim s address or any other identifying information shall be confidential
7.3.2. A treatment plan, clearly defining and measuring participation, attendance, homework assignment completion, consistency of attitudinal change, all aspects of non-violent expectations, to be reviewed monthly is expected. Said plan will be shared with the victimís therapist, courts and parole and probation officers, who are part of the therapeutic treatment team
7.3.3. The standard by which perpetrators shall be held accountable is demonstration and consistency in accepting full responsibility for their thought patterns, behaviors and actions. This includes development of a moral and legal concern and empathy for all victims.
7.3.4. All therapeutic contacts with the clients will be intellectually, culturally and linguistically commensurate with expected standards of ethics of the helping professionals that includes treatment that is understandable to the client.
7.4. Content of Treatment Program
7.4.1. Agreement for non-violent behavior toward a partner, in place of violent or abusive behavior.
7.4.2. Patterns of and cycle of violent or abusive behavior.
7.4.3. family of origin's intergenerational patterns that model and transmit violence as a taught and learned behavior.
7.4.4. Time Outs - client removes self from potential violent encounters.
7.4.5. Myths and beliefs regarding provocation.
7.4.6. Control Plan - clients' specific plan to control and prevent himself from acting violently.
7.4.7. Tactics of power and control that include isolation, emotional abuse, economic abuse, sexual abuse, using children, using male privilege, intimidation and covert to overt threats.
7.4.8. Aggressive behavior control.
7.4.9. Stress management.
7.4.10 Sex role socialization and training and its impact on beliefs, attitudes and behaviors toward the client's use of violent and abusive acts. The focus is upon clientís accountability and responsibility.
7.4.11 Conflict resolution.
7.4.12 Communication skills and training.
7.4.13 Owning, re-experiencing and taking responsibility for one's acts of violence.
7.4.14 Personal and cultural attitudes toward the opposite sex, to include attitudes of women hating or men hating.
7.4.15 Cultural and societal basis for violence to include values, beliefs and behaviors as institutionalized in a patriarchal society.
7.4.16 Definitions of alcoholism and other forms of substance abuse, their impact on the abuser and on the family system.
7.4.17 Parenting issues and skills as related to the impact of domestic violence on children. This may include successful completion of a recognized parenting program at another agency.
7.4.18 Skills for gaining intimacy in relationships.
7.4.19 Guilt and shame issues of the clients related to his violent and abusive actions.
7.4.20 Power sharing and decision making issues in a relationship.
7.4.21 Non-violence and equality model for relationships that include non-threatening behavior, respect, trust and support, honest and accountability, economic partnership, negotiation and fairness and responsible parenting.
7.4.22 Identifying danger signs of relapse behavior and how to prevent it.
8.1 Therapists' judgments and information from the victim and/or relevant agencies will be used to determine whether a client will be given either an administrative discharge or certificate of completion. A certificate of completion will be given under the following conditions:
Successful completion of the program with fulfillment of the client contract.
8.2 An administrative discharge is given under the following conditions:
An inability to continue in the program (e.g., a move out of state or a referral to another treatment program).
8.3 Termination from the program will occur under the following conditions and win include a written summary of the perpetrator's behavior in treatment.
Violation of the conditions of the client contract.
8.4 Re-admission, following a termination, is permitted based on re-evaluation by the court authorities, either the probation officer or prosecutor and the treatment provider.
8.5 At the time discharge or termination is being considered, if the client continues to exhibit behavioral signs of violence, the treatment provider must do the following in a timely manner:
8.5.1. Contact the victim, if possible.
8.5.2. Contact court officials, including the parole/probation officer and/or prosecutor and Child Protective Services and provide a statement of the client's progress and standing in the treatment program with a recommendation regarding termination of or continuation in treatment.
8.5.3. Ask the client to continue in therapy with increased involvement or refer the client to another treatment program.
8.6 At discharge:
8.6.1. Contact the victim, if possible.
8.6.2. Handout discharge packet, including Certificate of Completion, an evaluation with recommendations and referral sources for future services.
1. DEFINITION SECTION
Certified Treatment Program: An individual or organization that advertises or sets itself forth as having the capacity to treat domestic violence perpetrators that has received Full or Conditional Certification by the Evaluation and Monitoring Committee.
Committee: The committee on domestic violence appointed pursuant to NRS 228.470.
Coordinated Community Response: Means on-going, consistent communication among treatment programs the justice system, social services, victim services and medical personnel for the purpose of holding domestic violence perpetrators accountable.
Domestic Violence: Acts committed by a perpetrator against a victim that include: physical violence; sexual violence; and psychological abuse that is perpetrated the context of prior acts of physical and sexual violence, destruction of property and pets and economic abuse.
Note: For these STANDARDS, domestic violence is to be understood as such acts by one adult against another adult, who are either: presently married to one another (whether living together or separately); formerly married to one another; cohabiting; formerly cohabiting, dating one another or formerly dating one another. Therefore, for these STANDARDS, domestic violence is clearly to be understood as defined differently from child abuse or neglect, insofar as in child abuse and neglect the perpetrator is an adult and the victim is a child. As stated in NRS 33.018:
33.018. Acts which constitute domestic violence
Domestic violence occurs when a person commits one of the following against or upon another to whom he is related by blood or marriage, with whom he is or was actually residing, with whom he had or is having a dating relationship or with whom he has a child in common, or upon his minor child or a minor child of that person:
1. A battery.
2. An assault.
3. Compelling the other by force or threat of force to perform an act from which he has the right to refrain or to refrain from an act which he has the right to perform.
4. A sexual assault.
5. A knowing, purposeful or reckless course of conduct intended to harass the other. Such conduct may include, but is not limited to:
(e) Destruction of private property
(f) Carrying a concealed weapon without a permit
6. A false imprisonment
7. Unlawful entry of the other's residence, or forcible entry against the other's will if there is a reasonably foreseeable risk of harm to the other from the entry. (1985, p.2283; 1995, ch. 359, Sec. 8, p.902.)
Domestic Violence Training: Is specific training that complies with the outline for methods and philosophy as described in the STANDARDS. The training will be acceptable if it is developed in conjunction with the local domestic violence community.
Emergency Temporary Protective Order (ETPO): An order for protection against domestic violence issued within 24 hours of a perpetrator's arrest.
Empowerment: Vesting personal power with the victim by stressing the right of persons to make their own choices, listening without judgment and providing validation of the victim's right to live violence free.
Extended Order: An extended order for protection against domestic violence.
Indigent Client: A perpetrator applying for program services who does not have a current ability to pay the full program fee.
Note: The agency will determine the perpetrator's ability to pay by obtaining a financial statement and applying indigence guidelines. One guideline should be chosen and applied consistently. A minimum of one per cent of indigent clients will be accepted by individual programs.
Perpetrator: A person who commits acts of domestic violence.
Program: A program for the treatment of persons who commit domestic violence.
Temporary Protective Order (TPO): A temporary order for protection against domestic violence (NRS 33.017).
Treatment Provider: A specific individual therapist or supervisor within a treatment program who provides direct care to either the perpetrator or the victim. All treatment providers and their supervisors must meet the minimum qualifications outlined in the STANDARDS and must work in a Fully Certified or Conditionally Certified program.
Victim: A person who is killed, destroyed, injured or otherwise harmed by or suffering from acts of domestic violence by a perpetrator.
Safety and Protection Plan: The Treatment Provider will plan with and give information to a person who is a victim or at risk for victimization of domestic violence. The plan will include information. procedures, steps and alternative actions that person needs to maximize their safety and protection from further acts of domestic violence. This Safety and Protection Plan is for the victim to be carried out by the victim, and therefore developed in close consideration with their unique circumstances. The choices of the victim are to be respected in regards to their implementing any or all steps of a Safety and Protection plan. The exceptions would be the unique situations in which a victim's capacity to act for their own safety and protection is severely impaired, i.e. actively suicidal homicidal, intoxicated, etc. For example, when a person is so severely injured they cannot act; when a medical or mental condition exists to the extent actions for the person's safety and care must be taken by the Treatment Provider as in a suicide risk situation requiring hospitalization; or, when intoxication from alcohol or influences of other substances preclude the individual's acting for their own safety and protection.
The principle of empowerment of the victim is to assist developing and implementing of each Safety and Protection Plan.
Therefore, to reiterate, the Treatment Provider is to be guided by and respect the choices of the victim, although the victim may not follow the recommendation of the Treatment Provider.
A Safety and Protection Plan will include but not be limited to the following elements:
1. Police emergency phone number.
2. Emergency phone numbers for Battered Women's Hotlines and Crisis lines.
3. Information and referral to legal medic4 advocacy, counseling and other resources as unique to the individual victim.
4. A list of shelters and their phone numbers.
5 . Temporary Protective Order (TPO) information, including where, how and when a TPO can be obtained.
6. Identifying clues and cues that are signals to the victim of increasing danger or another incident. An explanation of the Cycle of Violence will be provided. The earlier the victim identifies warning signs, the greater likelihood that victim can act for their own safety and protection before another act of violence.
7. Tangible plans for the victim's use in an emergency to get away from the perpetrator to include:
a. Keeping cash, checks, credit cards that would allow the victim to pay for immediate emergency needs whether they be temporary shelter, food or transportation.
b. Packing and keeping an escape bag of personal articles, clothing, important papers, i,e., children's medical records, birth records, Social Security cards, financial records.
c. Keeping a second set of keys (house, car, etc.)
d. Setting up warning codes and call for help codes with other family members, neighbors, professionals, etc.
8. Changing locks on residence when TPO in effect.
9. Alerting employer, schools and others to gain their assistance in providing safety and protection for the victim; for example, alerting an employer that a TPO is in effect restraining the perpetrator from the victim's place of employment.
10. Advocacy information that the victim may find helpful for her safety and protection, such as the necessity of married mothers notifying police within 24 hours of removing their children from the home.
11. Reviewing all of the above steps for their application to assure safety and protection of children. Specifically, alerting day care centers and schools to the existence of a TPO restraining the perpetrator from coming to the center or taking a child from the center.
12. Reviewing the Safety and Protection plan with the victim and, when appropriate, rehearsing specific tasks. Continue to review the plan in future contacts with the victim.
13. Alerting neighbors and apartment managers.
14. Taking photographs to document violence and putting photos in a safe place.
15. Telling attorney about 9-1-1 tape, if appropriate.
16. Saving phone message on tape.
17. Child support.
18. Exchanging children at a safe place.
Control Plan-. A Control Plan is the perpetrator's counterpart to the Safety and Protection Plan for the victim. It is to be developed by the perpetrator with the assistance of the Treatment Provider. The plan can be effective only insofar as the perpetrator uses it to control violent and abusive actions. The Treatment Provider should work with the unique needs and circumstances of each perpetrator in assisting with the construction of the Control Plan.
Below are some of the key elements of a Control Plan:
I . Identification of Anger Cues and rating them on a scale of I to 10.
a. Physical changes telling of increasing anger--internal and external
b. Fantasies and mental rehearsals of violent or abusive acts.
c. Red Flag Words used by perpetrator.
d. Emotional changes.
e. Negative self talk.
f. Red Flag Words used by partner.
2. Time out steps to control violent and abusive acts-
a. Decide on the specific rating at which they will stop escalation of conflict, for example, at a level of 5 on a scale of I to 10.
b. Know what to do when taking time out, for example, leave the room or house and go for a walk.
c. Know what not to do when taking time out, for example, no drinking, drugging, driving.
d. Know where to go, for example, to the park.
e. Follow the recommendation that time outs are to be one hour in length; practice time outs, half-hour.
f. Announce the time out or give a neutral time out sign to their partner.
3. Steps to use during Time Out
a. Identify primary feelings.
b. Identify self-angering thoughts, such as labeling, personalizing her behavior, catastrophizing.
c. Omit negative self-talk
d. Begin positive self talk.
e. Call a friend, a group member, a crisis line to assist in de-escalating oneself during the time out.
4. Provide and rehearse the steps required. Include a written statement of commitment to remain non-violent.
5. Identify stress cues and rate them on a scale of I to 10.
6. Do positive activities to manage stress for prevention of stress overload. For example, a physical exercise program of three times weekly for at least 20 minutes each time.
7. Use the Control Plan regularly.
Client Contract: The treatment agreement between the certified treatment agency and the perpetrator.
It must include the following:
1. An agreement to be free of all forms of violence as defined in Section 3.0 during the time in treatment.
2. Accepting responsibility for previous violent behavior.
3. An agreement specifying the number of sessions of the treatment program and the program's allowed number of missed sessions.
4. An agreement not to use sexist or racist language in the group.
5. An agreement to meet financial responsibilities for treatment.
6. An agreement to be alcohol and drug free during treatment if this is indicated during the evaluation process.
7. Signed releases of information by the perpetrator allowing the treatment provider to share information with the victim the court and other agencies as determined relevant for assessment and treatment of the perpetrator.
8. An agreement to fully cooperate in therapy by talking openly and processing personal feelings.
9. A confidentiality agreement delineating the exceptions to client/therapist confidence These include admissions or threats of child abuse and evidence that a risk is imminent of violent actions by the perpetrator.
10. An agreement to respect the confidentiality of the other members of the group.
11. An agreement not to violate TPO's or other orders of the court such as conditions of probation.
12. An agreement to use a crisis response plan.
13. An agreement to meet court-ordered family obligations. Violations of any of the terms of the Client Contract may lead to termination from the treatment program and notification to the referring agency. Specific violations will lead to termination and notifications as defined in the STANDARDS Section 7.1.8 and Section 8.3.
The contract must be signed by the client and witnessed by the treatment provider.
Intake Evaluation: The following is a guide for the steps and content of an Intake Evaluation:
1. Face Sheet: Completed by client.
a. Basic identifying information.
b. Demographic information.
c. Client Survey (Client's description of the incident that led to his or her referral to counseling. Because it is written by the client, you will be able to form subjective impressions of his or her verbal skills as well as the extent of denial or minimization of violence.)
2. Inventories: Completed by the client. Inventories listed here are suggestions. Treatment programs are encouraged to submit other instruments for the review committee's consideration. Administer one or more as assessment for treatment:
a. Comprehensive Inventories:
1) Domestic Violent Inventory (DVI)
b. Violent and Abusive Behavior and Checklist.
1) Sonkin Inventory.
2) (D.A-P.) Domestic Abuse Project Violent add Abusive Behavior Inventory
c. Alcohol and Substance Abuse Inventories.
1) (MACH) - Minnesota Assessment of Chemical Health.
2) (ASI) - Addiction Severity Index
d. Depression and Suicide Risk Inventories.
1) Beck Depression Inventory.
2) Beck Hopelessness Inventory.
e. Stress and Isolation Inventories.
1) Social Readjustment Rating Scale (Revised)
2) Barksdale Stress Evaluation
3. Intake Interview Outline - An outline of information to be completed by the Treatment Provider during the intake interview.
a. Patterns and history of physical violence, sexual violence and other abusive acts against a partner to include:
1) Most recent incident of physical violence.
2) Incident that brought them to the program
3) First incident of use of physical force.
4) Most severe, serious incident.
5) Incidents that caused injury to partner.
6) Frequency of incident.
7) Incidents in which objects were used as weapons or weapons were used.
8) Incidents of sexual coercion, forced sex and/or rape of a partner.
9) Use of the following tactics of power and control against a partner as assessed from the "Tactics of Power and Control Wheel"
b) Emotional abuse.
d) Using male privilege.
e) Sexual abuse.
g) Using children.
h) Economic abuse.
10) Incidents of surveillance of a partner such as following them and spying on them
11) Threats to kill the partner.
b. Patterns and history of relationships with intimate partners to include:
1) Present relationship status: dating, living together, married, separated, divorced, etc., and degree of anger and frustration or anxiety regarding relationship.
2) Number of relationships and/or multiple separations in one or several relationships.
3) Identification of those relationships in which client was violent and abusive.
4) Sexual relations pattern, specifically degree of coerciveness or use of force in sexual relations.
5) Jealousy and possessiveness toward partner, including degree of obsessive thoughts about the partner and fear of losing partner.
6) Most significant heartbreak and loss of love experiences, and how lived through, how recovered, or other responses such as withdrawal from loving or seeking revenge.
C. Family of origin present status and history of specific problems to include:
1) Domestic violence by one parent against the other parent or parent figure.
2) Abus4 neglected or abandoned as a child by one or both parents or parent figures.
3) Sexually abused as a child by one or both parents, parent figures or other family members.
4) Alcoholism, alcohol abuse, drug addiction or drug abuse.
5) Mental illness.
6) Suicides in family of oil
7) Murder of member or members of family of origin.
8) Homicides by members or members of family of origin.
10) Death of a parent(s) or parent figure(s).
11) Violence by siblings against brothers or sisters or others outside the family.
12) Form of discipline by parents or parent figures.
d. Same sex peer group membership and belonging present status and history to include:
1) Present group(s) to which now belong or with whom associated.
2) Amount of time spent with group(s).
3) Nature of group's activities.
4) Attitudes of group members toward opposite sex.
5) Use of alcohol or drugs by group members.
6) Acts of violence or abuse by group members as known to clients.
7) Client's beliefs about actions group members would take if they knew about client's violence against partner.
8) Actions taken by group members if they do know.
9) Lack of same sex peer group and/or pattern of isolation including few friends or friendships.
e. Opposite sex friendship(s) - present status and history to include:
1) Number of if any, friends of opposite sex.
2) Length of friendship(s).
3) Nature of friendship(s).
4) Experiences of and beliefs about partner's responses to clientís opposite sex friendship(s).
F. Other violence - history of violent behavior against others than an intimate partner to include:
1) As a cud or a teenager acts of violence committed such as fighting in school fist fights or fighting in sports.
2) Participating in or witnessing gang violence or violence in the neighborhood.
3) As an adult acts of violence such as street fights, fights in bars, or fights with peers while in the military.
4) Training for fighting such as boxing, karate, judo, etc.
5) Arrest(s) and criminal record for violent acts.
6) Prior TPO's against the client.
7) Violent acts committed against siblings or other family members.
G. Alcohol and substance use, abuse or addiction history to include:
1) Brief history of alcohol and drug use, including most recent use and impact on any significant areas of life.
2) Arrest, DUI's related to alcohol or drug use.
3) Counseling or treatment for alcoholism or drug addiction.
h. Medical and mental illness history to include:
1) Suicide ideation, attempts or crisis.
2) Hospitalization for mental illness.
3) Acute or chronic depression.
4) personality disorders diagnosed or diagnosable.
5) Head injuries that could precipitate violent actions.
6) Medications now taking or having taken.
7) Previous counseling, psychotherapy or psychiatric assistance.
8) Chronic physical illness - diagnosed and duration.
I. Conflict patterns to include frequency, severity and style of conflict in other relationships with:
1) Family member.
6) Authority figures, such as police.
J. Environmental and situational stressors to include:
1) Present financial standing (income and indebtedness).
2) Stability of present employment, if employed.
3) Brief or chronic unemployment.
4) Sources of additional financial support.
5) Employment conflict threatening to job.
6) Illness of family member.
7) Separation from spouse by job requirements or military deployment.
8) Other environmental or situational stressors.
K) Child care and disciplining of children, to include:
Child care performed primarily by client or partner (approximate number hours of child care performed daily and weekly).
2) Methods and patterns of physical discipline of children, such as:
a) Spanking with hand.
b) Spanking with object such as a belt.
c) Slapping child on face.
d) Hitting child with fist.
e) Other forms of physical discipline.
3) Methods and patterns of other forms of discipline of children, such as:
b) Room confinement.
c) Sit in comer.
d) Giving chores.
e) Removing privileges.
f) Consequences directly related to offending behavior.
g) Others stated by client.
L. Lethality risk assessment to include:
1) Present and past threats to IL the partner - overt and covert.
2) Use of weapons such as knives, guns, heavy blunt instruments such as a baseball bat or other potentially lethal weapons against a partner.
3) Possession of lethal weapons.
4) Presence/absence obsession, possessiveness, jealousy regarding the partner.
5) Present and past suicide crises in which killing the partner would be the first act.
6) Violations of a TPO with demonstration of little concern for consequences of arrest and jail time.
4. Independent records and description of the client's acts of violence and abuse that may be reviewed and used in the intake interview, assessment and treatment planning, as available.
a. Police report from time of arrest.
b. Investigator's report.
c. Prosecutor's investigation.
d. Victim's statement.
e. Court transcript.
f. Statements on the TPO.
g. Medical reports from examinations of the victim, that may include photographs.
h. Witnesses' statements.
i. Probation officer's report.
5. Release of information signed by client authorizing exchange of information between the treatment provider and the following individuals or agencies, as appropriate:
a. The victim
b. The court.
c. The probation officer.
d. Previous therapists and present therapist.
e. The shelter.
f. The prosecutor.
g. Child Protective Service.
h. Medical personnel such as a doctor.
i. Family of the perpetrator.
j. Family Mediation and Assessment Center.
NOTE: The Release of Information should be limited to those individuals and agencies relevant to each perpetrator. The safety and protection of the victim remains an underlying rationale for the Release.
6. Client Contract to be reviewed in detail with the client by the treatment provider and signed by the client. (See the guide for a client contract in the previous section of the STANDARDS). The treatment provider also signs as the witness.
7. Other forms and matters that should be reviewed with the client at the intake evaluation are:
a. Fees and payment procedures.
b. Schedule of group sessions.
C. Group rules.
d. Goals of the Treatment Program
e. Books and materials to be used in the program
8. Treatment Provider's Impressions: The information gained from the various reports, statements, inventories and intake interview will be the basis for the judgments made about the perpetrator regarding the following:
a. Perpetrator's acceptance of or denial of responsibility for violent acts committed.
b. Perpetrator's level of commitment to attend.
c. Perpetrator's ability to use the type of treatment the program offers and, if judged unable or inappropriate the action directed by the STANDARDS should be taken. For example:
1) If actively alcoholic or drug addicted and detox is required chemical dependency treatment is to precede the treatment for domestic violence if detox is required. Otherwise, addiction treatment may be concurrent with domestic violence treatment.
2) If mentally ill such as psychotic, appropriate psychiatric and medical care is to be provided first.
3) If unable to tolerate involvement in a group, as with some persons with schizoid personalities, individual treatment or psychiatric evaluation may be required.
9. Treatment Plan: Treatment Providers will end the intake procedure by drawing up a
Treatment Plan which should include the following:
a. The decision regarding the client entering the treatment program:
1) Admission into the program now.
2) Deferred admission, with a referral out to address one of the several problems identified earlier, before beginning treatment.
3) Referral to another treatment program through the original referring source, because of considerations that would make the other program more appropriate; reasons may be geographical location, fees, or inability to begin the clientís treatment in the time required by the court.
4) Rejection of the client from the treatment program due to lack of cooperation with any aspect of the program
b. The Treatment Plan will specify the stages of the treatment program and inform the client of other services available per the guidelines of the program:
1) Individual treatment sessions at a particular time of crisis or upon successful completion of group treatment.
2) Couple treatment sessions after successful completion of group treatment as guided by the STANDARDS as verified by the perpetrator's partner.
3) A problem solving meeting of the victim and perpetrator on an as needed basis, for example, to make child visitation arrangements.
c. The Treatment Plan will address the fall range of the clientís assessed needs as related to the clientís violent and abusive behavior. Only those conditions or problems that are identified and agreed upon by the STANDARDS will be treated before addressing the violence, specifically alcoholism, drug abuse or severe psychopathology such as psychosis.
d. Notification of the disposition and the Treatment Plan will be provided the referral sources. This notification must be in writing.
e. A written statement of the Treatment Plan will be maintained in the Treatment Program's records with other documents contained in the individual client's case.
10. Summary of the nine elements outlined in the above Intake Evaluation Guide:
a. Face Sheet
c. Intake Interview Outline
d. Independent records and descriptions of the perpetrator's violent acts.
e. Release of Information
f. Client Contract
g. Other forms and matters
h. Treatment Providers impressions
i. Treatment Plan
Treatment Evaluation and Monitoring Committee: The committee will be formed by the Attorney
General and comprised of
(a) One staff member of a program for victims of domestic violence;
(b) One staff member of a program for the treatment of persons who commit domestic violence;
One representative from an office of the district attorney with experience in prosecuting criminal offenses;
(d) One representative from an office of the city attorney with experience in prosecuting criminal offenses;
(e) One law enforcement officer;
(f) One provider of mental health care;
(g) Two victims of domestic violence; and
(h) One person who:
(1) Has successfully completed a program for the treatment of persons who commit domestic violence;
(2) Has not committed a violent act following such treatment; and
(3) Has demonstrated leadership by assisting persons who commit domestic violence
or victims of domestic violence;
At least two members of the committee must be residents of a county whose population is less than 100,000.
2. The committee shall:
(a) Adopt regulations for the evaluation, certification and monitoring of programs for the treatment of persons who commit domestic violence;
(b) Review, monitor and certify programs for the treatment of persons who commit domestic violence pursuant to procedures delineated by NRS 233.B.03 1, Sections 12 to 46.
(c) Review and evaluate programs provided to peace officers for training related to domestic violence and make recommendations to the peace officers' standards and training committee regarding such training;
(d) To the extent that money is available, arrange for the provision of legal services, including, without
limitation, assisting a person in an action for divorce, and
(e) Submit on or before March I of each odd-numbered year a report to the director of the legislative
counsel bureau for distribution to the regular session of the legislature. The report must include,
without limitation, a summary of the work of the committee and recommendations for any
necessary legislation concerning domestic violence.
3 . The committee shall, at its first meeting and annually thereafter, elect a chairman from among its members.
4. The committee shall meet regularly at least semiannua4 and may meet at other times upon the call of the
chairman. Any five members of the committee constitute a quorum for the purpose a voting. A
majority vote of the quorum is required to take action with respect to any matter.
5 . The attorney general shall provide the committee with such staff as necessary to carry out the
duties of the committee.
6. While engaged in the business of the committee, each member and employee of the committee
is entitled to receive the per them allowance and travel expenses provided for state officers
and employees generally.
The committee on domestic violence shall begin distributing applications for the certification of programs for the treatment of persons who commit domestic violence to courts and facilities that provide treatment for persons who commit domestic violence on or before August 31, 1997.
The committee on domestic violence shall begin reviewing applications for the certification of programs for the treatment of persons who commit domestic violence not later than October 1, 1997.
Exceptions: Per the Evidence Code and Tarasoff Rulings:
Section 1017 - No privilege exists as to a confidential communication made to a psychotherapist who is appointed pursuant to court order to examine the patient. This exception does not apply where the court has appointed a psychotherapist at the request of defendant's lawyer in a proceeding for the purpose of determining whether defendant should enter a plea based on insanity or base a defense on his or her mental or emotional condition.
Section 1018 - No privilege exists if the services of the psychotherapist were sought or obtained to enable or aid anyone to commit or plan to commit a crime or tort to escape detection or apprehension after the commission of a crime or a tort.
Section 1020 - No p6Aege exists in a proceeding where either the psychotherapist or the patient alleges a breach of duty, such as in a malpractice action, arising out of the therapeutic relationship.
Section 1023 - No privilege exists in a proceeding initiated at the request of a defendant in a criminal action to determine his or her sanity.
Section 1024 - No privilege exists when the psychotherapist believes that patient's mental or emotional conditions causes him or her to be a danger to himself or herself or to others and the disclosure is necessary to prevent that danger.
Section 1025 - No privilege exists in a proceeding brought by the patient to establish his or her competence.
Section 1027 - No privilege exists where the patient is under 16 years of age and the psychotherapist has reason to believe the child has been the victim of a crime and the disclosure is in the best interest of the child.
TARASOFF V. BOARD OF REGENTS
When a psychotherapist determines that his or her patient presents a serious danger of violence to another, the psychotherapist incurs an obligations to use reasonable care and make a reasonable effort to protect the intended victim The psychotherapist is required to take one or more steps to prevent the violence. It may be necessary for the psychotherapist to warn the intended victim of the danger, warn individuals who in turn would warn the victim, notify the police, or take other steps which are reasonable under the circumstances. Disclosure should be discreet and accomplished in a fashion that preserves the privacy of the patient to the fullest extent compatible with the prevention of the threatened violence. In making the determination that a patient presents such a danger, the psychotherapist need only exercise the degree of skill knowledge and care ordinarily possessed and exercised by other psychotherapists under similar circumstances.
The court's ruling in Tarasoff is that by entering into a psychotherapist-patient relationship, the psychotherapist assumes some responsibility for the safety, not only of the patient, but also of any third person whom the psychotherapist knows to be threatened by the patient.
The notification by a psychotherapist of an intended victim or others does not constitute a breach of confidentiality. Section 1024 of the Evidence Code states that there is no privilege if the psychotherapist has reasonable cause to believe that the patient in such mental or emotional condition as to be dangerous to himself or to the person or property of another and that disclosure of the communication is necessary to prevent the threatened danger. Note Section 1024 permits the disclosure of otherwise confidential communications under specified circumstances. Tarasoff speaks to a narrower set of circumstances under which there is a duty to take actions for reasonable care to protect the victim from the threatened harm and as interpreted by some as a duty to warn and includes a potential liability for failure to act. The duty to disclose to prevent harm does not arise where risk of harm is self-inflicted or more property damage. Bellah vs. Greenson,
CRIMES AND TORTS (Evidence Code Section 1018)
When a patient tells a psychotherapist that he or she has committed a crime or tort, the information is privileged. However, there is no privilege if the services of the psychotherapist were sought to aid in the planning or commission of the crime or tort to escape detection or apprehension.