Q.   

A former employee of our center is alleged to have abused one or more children in one family during a time in which the ex-employee provided services to the individual(s). 

Is it advisable to continue to provide services to the family under these circumstances? Should arrangements be made for care by another provider? Should care by another provider be paid for by our center? Do we have an obligation to inquire about the ex-employee's contacts with other patients who continue to receive services? Do we have an obligation to contact persons who no longer receive services but who were served by this ex-employee?
 

A.

First, you should do a thorough investigation to determine whether the allegations of sexual misconduct are accurate. The Mental Health Risk Retention Group has previously provided its insureds a case study which described a 15 step procedure for investigating sexual misconduct allegations. I recommend that you review the case study and follow the procedure described. Among other things you should interview the former employee's supervisor and coworkers and assemble and protect various documents including personnel files and policies in effect at the time. I understand that the local prosecutor has filed a criminal charge and that the Department of Children and Families has also conducted an investigation. If you can obtain copies of the results of either investigation it would be helpful to do so.

Second, in regard to whether you should continue to provide services to a child alleged to have been abused by an employee or arrange for care to be provided from another source, it is my recommendation that you determine what would be in the best interest of the child and do that. Because the family may be upset with your center and thus more likely to find fault with continuing service, if it is in the best interests of the child to transfer treatment to another provider it is prudent to do so.

In the process of determining what is in the best interest of the child, I recommend that you consult an independent, appropriate mental health care provider so that you get an objective analysis. Among the things you should consider are the following: (1) possible disruption to any current, positive therapeutic alliance, (2) the availability from private sources of the full range of care you provide including case management services, (3) the affordability of other care, (4) your center's relationship with the family and (5) the availability of competent private care.

Third, in regard to whether you should contact other patients, if you have some reason to believe that the employee had some type of inappropriate contact with a patient you should interview that patient. During your investigation in accordance with the 15 step procedure recommended in the case study you may determine that other patients may be potential witnesses and therefore, it would be appropriate to contact the patient as a potential witness. It would not be prudent risk management to indiscriminately contact all former patients.

I suggest that you do not make final decisions until you have completed the 15 step investigation procedure so that you make your decision with as many of the facts as possible.

Fourth, in regard to risk management guidelines for in home, community-based treatment services it seems to me that the main risk management issue here relates to the possibility of sexual misconduct accusations and boundary violations.  Your staff should not go to a patient's home unless the visit is part of an established program and included within a written treatment plan. To the extent possible your staff should either go to the home with another staff member or arrange for another family member to be present during the visit. I also suggest that your center have a mandatory training for all staff for consideration of: (1) proper handling of transference, (2) observing boundaries and (3) the prohibition of sexual contact with clients by your center and other regulatory agencies.