Ethical Issues In Foster Care

I have been seeing my 15-year-old client, Alicia, for some time now. She reports that she was a foster child after both of her parents were incarcerated for drug and child abuse. She is currently living with her maternal grandparents but has disclosed that when she was in the foster system she was sexually molested. Alicia has been slow-to-warm but it appears that we are establishing rapport as she is beginning to show more positive affect. Nevertheless, in our most recent session, Alicia appeared to be “high” and disclosed that her uncle has returned from war and is staying with her and her grandparent. Alicia reported that he has been molesting her and that despite this she has does not want to go back into the foster system but only told be to tell someone safe.

In this case, my immediate reaction is that legally, this is abuse and my duty is to report. This is not only an old case of abuse, from the foster care, that I am unsure if the it has been reported but also the new case of abuse from her uncle. Ethically, however, the potential issues I face is my

client’s autonomy. Although I would like to grant her that right and validate her for being able to see therapy as a safe place, it would be completely unethical and against the law for me not to report the abuse. In addition, by not reporting I would not be complying with the moral principles of nonmaleficence and beneficence in particular.
Nonmaleficence requires that I do no harm if I was not to report this sexual abuse I would only be allowing the abuse and harm to my client. Additionally, beneficence requires that I promote the welfare of my client. In not reporting the abuse I would only continue to decrease her overall welfare. Although Alicia might argue that her welfare is better off with her grandparents, which I might agree to if the uncle was no longer in the home, with the current situation I cannot risk my client to continue being abused while he is in the home; thus, I must report. As plane as it gets, sexual abuse, assault, and exploitation must be reported (coercion; 288, 647.6, 11165.1(a) & (b)).
I feel confident that it is my legal and ethical responsibility to report. Nevertheless, I would also make a report against the foster care agency that my client was previously in due to the sexual molestation she experienced there. It would be unethical for me to report the current sexual abuse and allow her to return to an agency where she has been molested before. Although it is stated that the “system” also fails to protect from this and other types of abuse, I would advocate for my client that if it was required for her to go back into the system that she does not go back to the previous agency.
The consequences of making the report immediately could produce the outcome of Alicia going back into the foster care system, which is something she explicitly states she does not want to be moved from her grandparent’s house because it is the best situation she has been in, despite the abuse from her uncle. Another possible outcome of reporting is that the uncle could be removed from the home and not be allowed to her Alicia at least unsupervised. Nevertheless, there are risks with this choice. I would be concerned that without legal action or paperwork enforcing the uncle to not live in the home with Alicia, I would be worried that he might not comply or the compliance would not be maintained.
Furthermore, another possible outcome in reporting the abuse despite Alicia’s explicit request not to is that our client-therapist relationship is likely to be ruptured. Therefore, it is imperative to explain to Alicia my ethical and legal responsibilities in this case. In this case, one strategy I would use is referring to my informed consent with Alicia; which would include my legal and ethical responsibilities to report. In order to avoid rupturing the relationship entirely, I would like to thoroughly discuss with Alicia why it is important that I report for her sake and my responsibility as her therapist. Additionally, I would want to review with her the potential outcomes of this situation. Including that, I would also report the previous abuse when she was in the foster care system.
My decision to report is a difficult one; however, especially when considering how slow-to-warm Alicia was through the course of therapy. It is very likely that Alicia will become upset and reluctant to continue with therapy. For this reason and those mentioned prior, I would stop Alicia from telling me more and inform her of the decision I have to make to report, and explain to her my reasons and what options she has and that if she does not want me to report anything else she has the right not to say anything further. It need be, I would even show her the California Penal Code 11165.7(a)(21) & 11166, which states that if I have reasonable suspicion of abuse I am to report and in this case because she has explicitly told me, even under the influence, I must report the abuse.
Ultimately, one of my primary concerns about reporting is that the initial case Alicia disclosed happened while she was in the foster care system.

I would be concerned about her safety and the possibilities of this happening again. Although I would also make a report on the previous foster care agency she was in, just knowing that the system and other placements they are sent to sometimes fail to protect the children from sexual predators and kinds of abuse is concerning. Additionally, unfortunately, it is the case that those who have been abused have a higher likelihood to be abused again. Therefore, it would be in Alicia’s best interest and my ethical responsibility to advocate for my client if she must go back into the system that she is set up in a safe environment until other arrangements could be made (if she was ever able to return to her grandparents’ house again once her uncle was

removed).
In conclusion, although the client-therapist relationship has the potential to rupture, it is my legal and ethical responsibility to report the abuse. It would be my responsibility to report the past abuse; however, there is current abuse that is happening and I have no other choice but to report. Nevertheless, due to my client’s explicit request as to not report because she does not want to be removed from her grandparent’s house, I would want to do everything in my power to help my client understand the risks of staying in the home and my responsibilities. Furthermore, I would advocate on behalf of my client and do everything within my power to make sure she is safe with the outcome of my reporting the abuse.