MFT Practice Question: Child Abuse and Neglect

In Wednesday’s blog, Bethany reviewed a question on child abuse and neglect reporting. Since this is a question that will likely appear more than once on your licensing exams, let’s continue with this topic. While it’s a topic that has historically caused therapists uncertainty and anxiety both as practitioners and test takers, it is not one you need to fear!

When Amanda Rowan created TDC’s test prep materials, it was important to her not only to build your skills as a test taker, but to also allow you to bring that new knowledge into your clinical practice. This was something I loved about the program when preparing for my own licensing exams and is common feedback we receive from other therapists who study with TDC.

With that in mind, let’s dive into our question and figure out how we would approach this situation and choose the best answer!

A 17-year-old client with a diagnosis of Bipolar Disorder comes to a first session with her parents. The mother informs you that their daughter met with a psychiatrist who prescribed medication, but the family’s faith prohibits her from taking it. The parents tell the therapist they have been trying to “rid her of her demons by praying and relying on our faith.” You notice that the girl appears disheveled, is frequently distracted during the session, and seems agitated. What actions should the therapist take in this case:

A. Report the situation to CPS because client is a minor and she is not receiving proper treatment

B. Initiate involuntary hospitalization since the client is exhibiting clear signs of psychosis

C. Begin treatment with the client and maintain confidentiality due to religious exemptions with child abuse reporting

D. Explore the pros and cons of taking psychotropic medications with the parents and their daughter, while acknowledging their religious rights.

This scenario is particularly challenging because the law is a bit vague when it comes to child abuse reporting and religious freedom. If religion were not mentioned in this question, we would search for an answer that includes reporting neglect and be justified in doing so. However, religion is mentioned and the parents state medication is expressly prohibited within their religion. This makes choosing the right answer trickier. According to the Child Abuse and Neglect Reporting Act, “a child receiving treatment by spiritual means…or not receiving specified medical treatment for religious reasons, shall not for that reason alone be considered a neglected child (CA Penal Code 11165.2).” With this in mind, let’s evaluate our answer choices.

Answer:

The best answer choice in this situation is D. You likely ruled out answer B, since we would only initiate a 5150 (involuntary hospitalization) if there were a grave concern for the client’s immediate safety, something that is not indicated based on the information shared. Answer C can also be ruled out, since it completely overlooks several of the key concerns specifically noted in the question stem. Namely, the potential risks facing the client and medication compliance. This leaves us with options A and D. As the law indicates, if a child is receiving treatment by religious means, or not receiving treatment due to religious reasons, this does not necessarily constitute neglect. In this case, the child is receiving care, has been seen by a psychiatrist and is now seeing a therapist—the parents have just decided against psychotropic medication for religious reasons. In addition, failure to take the medication is not a life or death decision. For these reasons, we would not choose A. This leaves us with answer D, which gives us an opportunity to have an honest conversation with the family regarding medication while still respecting the family’s religious beliefs. This answer addresses all of the concerns mentioned in the question stem.

Which answer did you choose? Does the rationale fit with your understanding of the law and how you would work in the clinical setting? Or did you learn something new with this scenario? If you have any further questions feel free to check in with a TDC coach. We are here to support you all along the way. And if you came up with the same answer-great job! You are right on the right track to getting licensed.

Still haven’t signed up for an exam preparation program? Our structured, straightforward approach to exam prep will provide you with exactly what you need to pass your social work exam or MFT exam and nothing you don’t. You can learn more about our social work licensing exam prep HERE and more about our MFT licensing exam prep HERE. If you’d like to connect directly with one of our coaches, you can do that HERE.

We look forward to helping you PASS your exam with confidence!