When to Break Confidentiality — Clinical Decision Tree
Confidentiality has three exceptions. This decision tree walks through each one with specific assessment criteria, what the exception requires, and how to handle the client conversation.
What is in this decision tree
Three exception branches — mandatory reporting, duty to protect (Tarasoff), and imminent danger to self. Each with its own assessment sequence and response protocol.
Mandatory reporting guide — the reasonable suspicion standard, what qualifies as abuse or neglect for children and vulnerable adults, the situations that are commonly missed (ongoing access, DV exposure, historical disclosure), and the client conversation language.
Duty to protect assessment — the specific factors that distinguish a Tarasoff-triggering threat from frustration or general anger. Specificity, intent, means, history, imminence. Response options and the consultation sequence.
Imminent suicide risk branch — the threshold for when a voluntary safety plan is not sufficient, emergency intervention options, and the state-specific involuntary hold process (with a reminder to know your state’s law before you need it).
Documentation templates — specific language for mandatory report documentation, Tarasoff documentation, and imminent risk documentation. What your note needs to say and why.
Quick decision reference — situation mapped to standard and required action, in a one-page format.