~ z;:;---- Suzanne Grimmesey, MFT

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1 Pa g e 11 of 7 ALCOHOL, DRUG AND MENTAL HEAL TH SERVICES POLICY AND PROCEDURE Section Sub-section Clinical Practices and Services Effective: May 2006 Policy Policy# Duty to Warn/Protect Against Threats of Violence Director's Approval - ~ ~-"' -=./- --= Alice Gleghorn, PhD Chief Strategy Officer's Approval Form Ref. CL ~ A.,/'/ ~ z;:;---- Suzanne Grimmesey, MFT Authority: CEC 1010; CCC 43.92; WIG 5328 (statutes, regs, etc) Supersedes: P&P #66 - Civil Code ("Tarasoff") Warnings Last 10/14/15 Revised: Audit 10/14/18 : 1. PURPOSE 1.1. To ensure compliance with all state laws, regulations, and current professional practice and standards in the event that an Alcohol, prug and Mental Health Services (ADMHS) client has communicated a serious threat to physically harm a reasonably identifiable victim(s). 2. DEFINITIONS The following terms are limited to the purposes of this policy: 2.1. Psychotherapist - per California Evidence Code, Section 1010, means "a person who is, or reasonably believed by the client to be: A psychiatrist, licensed psychologist, licensed clinical social worker, licensed marriage and family therapist, or professional clinical counselor who holds a valid California license A person who is registered as a psychological assistant, associate clinical social worker, marriage and family therapist intern, psychological intern, clinical. counselor intern or trainee who is under the supervision of the appropriate licensed 'psychotherapist' as defined above."

Duty to Warn/Protect Against Threats of Violence Page I 2 of 7 3. POLICY 3.1. ADMHS will comply with Civil Code 43.

2 Duty to Warn/Protect Against Threats of Violence Page I 2 of 7 3. POLICY 3.1. ADMHS will comply with Civil Code , which requires a psychotherapist to warn and protect the intended victim(s) when a client has communicated to the psychotherapist a serious threat of physical violence. It is the psychotherapist's duty to make reasonable efforts to communicate the threat to the intended victim(s), inform a law enforcement agency and complete all associated documentation. 4. REPORTING AND DOCUMENTATION PROCEDURES 4.1. Should a client make a serious threat of physical violence against a reasonably identifiable victim(s), ADMHS staff will immediately notify his/her direct supervisor. The supervisor will immediately notify the client's assigned (or if unavailable, a designated) psychotherapist, psychiatrist and the ADMHS Medical Director If the psychotherapist determines that the intended victim(s) is in immediate or imminent danger, the psychotherapist will immediately notify the reasonably identifiable victim(s) by telephone and send a Duty to Warn Intended Victim Letter (see Attachment A). If notifying a class or group of intended victims (e.g. identified school, facility, or government building), directly contact management personnel (e.g. school principal or building manager) If the psychotherapist is unable to find a telephone number at which the intended victim(s) can be contacted, or if the psychotherapist is not able to speak with the intended victim(s), law enforcement will be informed that the intended victims were not notified The psychotherapist will report the threat by telephone to the local law enforcement agency with jurisdiction of the area in which the client resides and send a Duty to Warn Law Enforcement Letter (see Attachment B). Law enforcement must also be informed of any other identifiable individuals who may be in danger because of their close relationship to an intended victim(s) (e.g. spouse, children, and roommates). Document the officer's name, his or her department's mailing address and badge number The psychotherapist will complete the Duty to Warn Protocol form (see Attachment C). Staff will mail a certified copy to the law enforcement agency as well as each intended victim within 24 business hours of the threat being made. A copy of the form will be filed in the client's medical record under the "Legal" tab The psychotherapist will contact the United States Secret Service at (213) if the identifiable victim is the President of the United States, certain members of his or her family, former Presidents, or foreign heads of State (while they are in the United States). 1 Civil Code is based on principles outlined in Tarasoff vs. Regents of the University of California, 1976 (overruled), a case law that found a psychotherapist has a duty to warn, or take appropriate action to protect, the foreseeable victim of a client's violent tendencies.

3 Duty to Warn/Protect Against Threats of Violence Page I 3 of All details pertaining to notification and all procedures specified herein must be documented in the client's medical record Unlicensed staff will document all steps taken, including notifying the assigned or designated psychotherapist. This documentation occurs in the client's medical record The psychotherapist who received and reported the threat of violence will document all steps taken in the medical record. Based on discipline, the psychotherapist will document as follows: 1. Social services staff - Social Services Progress Note. 2. Nursing staff - "Interdisciplinary" section of medical record. 3. Psychiatrist - Physician's Daily Note The psychotherapist will complete an Unusual Occurrence Incident Report within 24 hours of receipt of the threat of violence Only the minimum information necessary to meet the need of completing the above steps will be disclosed. 5. Psychiatric Health Facility (PHF) Procedures 5.1. The PHF is a locked, secure setting supervised by staff 24/7. Patients hospitalized at the PHF may not pose an immediate threat to any identified victim(s) who reside outside the facility. However, in the event that a patient makes a serious threat to physically harm an individual while hospitalized, the PHF clinical team will conduct a daily clinical review of the patient's disposition and the seriousness of the threat. Duty to warn an intended victim(s) is triggered only if there is an explicit imminent threat Patients who have communicated direct threats are not to leave the PHF unit with the exception of urgent medical appointments or court mandated hearings. In these circumstances, the patient must be accompanied by two staff Duty to warn is immediately triggered in the event that the patient escapes or leaves the hospital by other means.

4 Duty to Warn/Protect Against Threats of Violence Page 14 of 7 ASSISTANCE Veronica Heinzelmann, LCSW, Director of PHF Social Services AUTHORITY/REFERENCE California Evidence Code Section 101 O California Civil Code Section Welfare and Institutions Code Article 7, Section 5328 Tarasoff v. Regents of the University of California, 1976 (overruled) Hedlund v. Superior Court of Orange County, 1983 (overruled) Ewing v. Goldstein, 2004 Mental Health Law: California Hospital Association 2015 Chapter 11: Reporting Requirements ATTACHMENTS Attachment A - Duty to Warn Intended Victim Letter Attachment B - Duty to Warn Law Enforcement Letter Attachment C - Duty to Warn Protocol REVI SION RECORD DATE VERSION REVISION DESCRIPTION

5 Duty to Warn/Protect Against Threats of Violence Page I 5 of 7 Attachment A.. ALCOHOL, DRUG & MENTAL HEALTH SERVICES Alice A. Gleghorn, Ph.D., Director 300 North San Antonio Road, Bldg. 3 Santa Barbara, CA (805) / FAX (805) Intended victim name Street Address City, State, Zip Re: Report mandated by Duty to Warn reporting requirements Dear name of intended victim: As a licensed psychotherapist I am legally obligated to fulfill Duty to Warn reporting requirements. Therefore, I called you on date and time and sent you this registered letter on date. It is my clinical opinion that client's name who resides at: address (telephone) represents a significant danger to you. You are urged not to visit, write or talk to this person. You are also a dvised to call law enforcement or 911 if this person approach es you. I regret any distress this information may be causing. However, this report is to reduce any possible danger associated with this person. I am not aware of any other persons who may also be in danger. I have also notified the local law enforcement verbally and in writing. Please do not h esitate to call them as needed. Sincerely, Name Title

6 Duty to Warn/Protect Against Threats of Violence Page I 6 of 7.. Attachment B ALCOHOL, DRUG & MENTAL HEAL TH SERVICES Alice A. Gleghorn, Ph.D., Director 300 North San Antonio Road, Bldg. 3 Santa Barbara, CA (805) / FAX (805) Law enforcement department. Street Address City, State, Zip Re: Report mandated by Duty to Warn reporting requirements Dear Officers: As a licensed psychotherapist I am legally obligated to fulfill Duty to Warn reporting requirements. It is my clinical opinion that patient's name who resides at: Patient's address (patient's phone number) represents a significant danger to an individual (identifying information e.g. whom the patient describes as a fo,mer employer whose name is "zxzx". The last name of this individual may be either "Thompson" or "Thomas".) I called name of law enforcement official of the Name of law enforcement department on date at time to make this report. I have been able/unable to locate the identified victim. I am not aware of any others who may also be in danger. Sincerely, Name Title

7 Duty to Warn/Protect Against Threats of Violence Page I 7 of 7 Attachment C SANTA BARBARA COUNTY ALCOHOL, DRUG AND MENTAL HEAL TH SERVICES DUTY TO WARN PROTOCOL Instructions: The psychotherapist who believes a client poses a violence risk to a kn own victim must complete the requirements below ALERT: : Hour: Client reports and/or Psychotherapist believes Client has violent: D Ideation Describe: D Intent Describe: D Plan Describe: D Weapons Describe: VICTIM: Has D Has not D been identified: Name/ Prompt Consultation: is required with: D Psychotherapist Name/ : Hour: And/or D Mgr. Name/ : Hour: Written and Verbal Notification: [When the Psychotherapist believes the identifi ed victim is in danger both victim and law enforcement must receive verbal and written (registered letter) notification within 24 hours or sooner. (See sample letters). Ag reement by Psychotherapist and/or Manager is not needed.] VICTIM: was D was not D located. If located, called by : Hour: and reg istered letter was sent on, : See enclosed. Law enforcement contacted by: on : Hour: Letter sent on, : Hour: See enclosed. Known others in possible danger? Yes D No D If yes, name them and provide verbal and written notifications. 1\1..,,.,..,,.,. on Verbal D and written (registered letter) notifications D provided on; : By Client must be hospitalized on 5150, danger to others. : If not, explain: Verbally Notified Medical Director or available clinical administration: : [Incident Report must follow] Hour: Hour: SiQnature: : 1~Hi M H S 01 3C PATIENT NAME: PATIENT NUMBER:

Disclosure Statement

Disclosure Statement The state of Colorado requires that I, as a licensed psychotherapist, provide the following items of information to you as a client: Business Address and Phone: Mooney and Associates,