Q.

We have been asked to give "daily living skills training" to an 18 year old learning disabled-repeat sex offender currently incarcerated for simple assault.  We do not anticipate providing treatment for his sexually offending behavior,  we will be treating for depression.  The client does not seem to be motivated to resolve his behavior, he has never acknowledged participation in the sexual assault. Please advise.
 

A.

I have a number of comments.  First, you should make it clear in a letter directed to the court system exactly what services you will be providing.  You should also make it clear that you will not be providing treatment for the client's sexually offending behavior.  I suggest that you inform the court that a referral should be made to another health care provider competent to treat sexually offending behavior.

Second, if possible obtain an indemnification agreement from the state or county indemnifying your agency for any claim arising as a result of the actions of the client.

Third, your state has a statute defining the responsibilities of a mental health care provider who has reason to believe that a client has the intent and ability to carry out an explicit threat of inflicting imminent and serious physical harm.  There is a risk that this particular client may make some type of comment which would create a responsibility to act in accordance with the statute.  I suggest that your staff be advised of the possibility that this may occur.  Further you should take action to be sure that each of the staff members who have contact with the client is aware if their responsibilities under the statute.

Fourth, a specific staff member should be assigned the responsibility to review all court orders relating to the client and to be sure that the orders are followed.  Additionally, there should be some follow-up system in place to be sure that as time passes any new staff member who have contact with the client are aware of the specifics of the court orders.

Fifth, appropriate members of your staff should review past records of other mental health care providers who have provided treatment to the client.

Sixth, you might want to seek a consultation from a mental health care provider outside your agency in regard to the most appropriate way to provide treatment for the client's depression.

Seventh, the client should be informed in writing exactly what treatment you will be providing and that you will not be attempting to treat his sexual dysfunction.  This letter should advise the client to seek treatment elsewhere for the sexual dysfunction.