New Haven Youth & Family Services, Inc.

Confidentiality & Mandated Reporting Policy

Client Name: ____________________________ Date of Birth: _________________________

All employees of New Haven Youth & Family Services are bound by a strict policy of confidentiality in most cases so that any and all information about you, your family members, and your personal life may not be used, discussed or disclosed to anyone outside of the paid employees of New Haven for any reason. There are of course times, when it may become necessary to speak to or with another person, agency, or service provider on your behalf and in these instances information can only be shared with your written and verbal consent (as documented on the Release of Information form). Therefore, the majority of the information that you disclose to us will remain between you and the members of your New Haven Treatment Team.

However, there are certain, specific people that are exceptions to this rule. The success of New Haven depends on a team approach and the mutual sharing of information with placing representatives, funding sources, regulatory agencies and those individuals or groups specified in our privacy practices. Please know that because of this, any placing agency worker who is or will be directly involved with your family has access to any and all records, notes, and information at any time. Ethically, we cannot withhold information or “keep secrets” from these or other team members. Therefore, by agreeing to place your son at New Haven, you acknowledge that information will be shared as needed with the appropriate county workers and/or their supervisors.

Additionally, there are also specific situations that require that confidentiality be broken. In both of the instances below, failure to report is considered Negligence and penalties include both fines and/or imprisonment. The first is if someone in your family is threatening to harm himself or herself or someone else. If there is indication that a threat is credible or sincere and possible, then, under California State Law and The Duty to Warn, appropriate authorities must be contacted. This could include, but may not be limited to, the local police, local hospitals, and in the case of harming another person, the person whose safety is being threatened.

In addition, every person who works for New Haven is a Mandated Reporter, meaning that by California State Law we are required to report ANY potential neglect, abuse, or maltreatment of a child or elderly person, that is brought to our attention, regardless of whether we believe the report to be true or false and regardless if there is any proof or indication. This includes but is not limited to:

  • Failure to provide or enforce age-appropriate rules & supervision for any child in your home.
  • Failure to provide a safe living environment for any child in your home.
  • Failure to protect any child in your home from harm inflicted by another sibling or caregiver.
  • Failure to provide medical insurance or medical attention for any child in the home.
  • Failure to provide any prescribed or recommended medication and/or treatment for any child in the home.
  • Signs, symptoms, or suspicions of neglect or emotional, physical or sexual abuse to any child in the home.
  • Claims or reports (even if likely to be false) of neglect or emotional, physical, or sexual abuse by ANY person regardless of the situation.
  • Misuse of drugs and/or alcohol by any adult in the home to the extent that he or she loses self-control, acts lewdly or inappropriately in front of any child in the home, is unable to adequately supervise any child in the home, or is likely to harm or cause harm to any child in the home.
  • Supplying or allowing the use of drugs and/or alcohol to any minor in the home.

If it becomes necessary for any employee of New Haven to contact CPS/CYFS for these or any other reason, it is our pledge to you that we will make every attempt to speak to you directly regarding the situation as soon as possible. In certain cases it may even be appropriate for the report to be made by you or in your presence. However, please be aware that regardless of what we personally believe has occurred, we are never at liberty to decide whether or not abuse has occurred. Our job is not to judge you, rather it is to make the report and then to assist and support you through the process.

Please understand that the intent of Mandated Reporting is NEVER to get you in trouble or to attempt to separate any members of your family. Instead, the sole purpose is help keep the family together and “to help ensure the well-being or all family members and preserve and stabilize family life.” And the sole purpose of our collaboration with CPS/CYFS following a report is “to help coordinate, provide, and arrange for services necessary to help insure that all members of your family can remain together in a safe and loving home without fear.”

Lastly, while it is never our intent to keep secrets between family members and all members will be encouraged and supported to reveal any and all information in the open and safe environment of the family session, in order for the therapeutic relationship to be effective, youth need to be able to trust that their thoughts, feelings, and even previous or current behaviors can be shared during therapy without fear of punishment, embarrassment, or loss of privacy. Therefore, information shared by the youth with their therapist in session (whether group or individual) will not be shared with anyone including parents, guardians, and/or other family members, unless it is judged by the therapist that the information shared puts the youth, family, or other person in serious and immediate danger. While parents can request a general, over-all summary of sessions with their child, the specific information shared in therapy stays within the confines of the therapist/client relationship.

If you ever have any questions regarding the boundaries of confidentiality or the requirements of the “Duty to Protect” or the Mandated Reporting Laws of the State of California please don’t hesitate to talk to your therapist. It is our pledge to you to always be open and honest with our families and all service providers who work with them in every situation and our top priority is protecting the privacy and safety of you and your family.

By signing below, you acknowledge that New Haven’s Confidentiality Policy and the requirements of The Duty to Protect and Mandated Reporting have been clearly explained to you. In addition, you agree that any county worker who is working with New Haven and your family in good faith, can have access to any and all records as deemed necessary by the worker and the therapist. Finally, you clearly understand that all actions taken are to be done in keeping with California State Law and are, in the opinion of the Treatment Team, in the best interest of the child and the family.


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Signature of Parent, Guardian, or Authorized Representative                                                                                                                                         Date


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Signature of NHYFS Representative or Witness                                                                                                                                                               Date