Legal and Forensic Issues and Resources

Legal and forensic issues in child and adolescent psychiatry are frequently intertwined with clinical, research and ethical issues in day-to-day practice. The articles below highlight the important considerations when performing a forensic versus a clinical evaluation as well as the legal and ethical issues raised by genetic research. CAPs have a duty to be knowledgeable and seek consultation regarding legal and forensic issues that present and may be beyond their expertise.

Forensic Psychiatry

  1. Kraus LJ, Thomas CR, Bukstein OG, Walter HJ, Benson RS, Chrisman A, Farchione TR, Hamilton J, Keable H, Kinlan J, Schoettle U, Siegel M, Stock S, Ptakowski KK, Medicus J. Practice parameter for child and adolescent forensic evaluations. J Am Acad Child Adolesc Psychiatry. 2011 Dec;50(12):1299-312. doi: 10.1016/j.jaac.2011.09.020. PubMed PMID: 22115153.
  2. Robinson J. The experience of the child witness: Legal and psychological issues. Int J Law Psychiatry. 2015 Sep-Dec;42-43:168-76. doi: 10.1016/j.ijlp.2015.08.022. Epub 2015 Sep 4. Review. PubMed PMID: 26343312.
  3. Sher L. Forensic psychiatric evaluations: an overview of methods, ethical issues, and criminal and civil assessments. Int J Adolesc Med Health. 2015 May;27(2):109-15. doi: 10.1515/ijamh-2015-5001. Review. PubMed PMID: 25411982.
  4. Thomas CR. Epigenetics and Child Psychiatry: Ethical and Legal Issues. Behav Sci Law. 2015 Oct;33(5):644-52. doi: 10.1002/bsl.2207. Epub 2015 Sep 11. Review. PubMed PMID: 26358684.
  5. Wills CD. DSM-5 and neurodevelopmental and other disorders of childhood and adolescence. J Am Acad Psychiatry Law. 2014;42(2):165-72. PubMed PMID: 24986343.

Abuse and Neglect Reporting

At times, the ethical principle of confidentiality will conflict with other critical ethical principles. These conflicts might arise when a child and adolescent psychiatrist (CAP) obtains information concerning suspected child maltreatment (i.e., child abuse or neglect). This information that might be needed to end child maltreatment and protect children. Each state has a system in place to receive and respond to reports of suspected child maltreatment. CAPs are expected to know what standards apply in their state of practice and must report any form of suspected child maltreatment that falls within those standards.

  1. Drake B, Jolley JM, Lanier P, Fluke J, Barth RP, Jonson-Reid M. Racial bias in child protection? A comparison of competing explanations using national data. Pediatrics. 2011; 27(3): 471-8. doi: 10.1542/peds.2010-1710. Epub 2011 Feb 7. PubMed PMID: 21300678.
  2. Lareau CR. Attorney work product privilege trumps mandated child abuse reporting law: the case of Elijah W. v. Superior Court. 2015. Int J Law Psychiatry. 2015,2015;42-43:43-8. doi: 10.1016/j.ijlp.2015.08.006. Epub 2015 Sep 26. PubMed PMID: 26404507.
  3. Newton AW, Vandeven AM. The role of the medical provider in the evaluation of sexually abused children and adolescents. J Child Sex Abus. 2010 Nov;19(6):669-86. doi: 10.1080/10538712.2010.523448. Review. PubMed PMID: 21113834.
  4. Pietranoio AM, Write, Gibson KN, Alldred T, Jacobson D, Niec A. Mandatory reporting of child abuse and neglect crafting a positive process for health professionals and caregivers. Child Abuse Negl. 2013; 37(2-3):102-9. doi: 10.1016/j.chiabu.2012.12.007. Epub 2013 Jan 19. PubMed PMID: 23337443.
  5. Schilling S, Christian CW. Child physical abuse and neglect. Child Adoles Psychiatric Clin N AM 2014; 23:309-19, ix. doi: 10.1016/j.chc.2014.01.001. Epub 2014 Feb 18. Review. PubMed PMID: 24656582.

Involuntary Commitment - Inpatient Psychiatry

When treating children and adolescents, involuntary commitment for psychiatric care is complicated by having to consider the opinions of the parents and the youth. While youth can be hospitalized voluntarily if their parents agree, having the child or adolescent disagree with the plan does complicate the situation. Assent/consent are major issues as well as best interests/no harm and development. Given that some populations are more likely to be involuntarily committed, advocacy and justice should always be considerations.

  1. Georgieva I, Vesselinov R, Mulder CL. Early detection of risk factors for seclusion and restraint: a prospective study. Early Interv Psychiatry. 2012 Nov;6(4):415-22. doi: 10.1111/j.1751-7893.2011.00330.x. Epub 2012 Jan 25. PubMed PMID: 22277018.
  2. Golubchik P, Server J, Finzi-Dottan R, Kosov I, Weizman A. The factors influencing decision making on children's psychiatric hospitalization: a retrospective chart review. Community Ment Health J. 2013 Feb;49(1):73-8. doi: 10.1007/s10597-012-9487-0. PubMed PMID: 22294510.
  3. Pelto-Piri V, Kjellin L, Lindvall C, Engström I. Justifications for coercive care in child and adolescent psychiatry, a content analysis of medical documentation in Sweden. BMC Health Serv Res. 2016 Feb 19;16:66. doi: 10.1186/s12913-016-1310-0. PubMed PMID: 26893126; PubMed Central PMCID: PMC4759758.
  4. Turunen S, Välimäki M, Kaltiala-Heino R. Psychiatrists' views of compulsory psychiatric care of minors. Int J Law Psychiatry. 2010 Jan-Feb;33(1):35-42. doi: 10.1016/j.ijlp.2009.10.007. Epub 2009 Nov 10. PubMed PMID: 19906428.

This section was designed to provide up-to-date federal and state laws pertaining to the practice of child and adolescent psychiatry.

Affordable Care Act (ACA) of 2010

The Affordable Care Act (ACA) is a comprehensive health care reform law enacted in March 2010 has 3 primary goals:

  • To make affordable health insurance available to more people;
  • Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level; and,
  • Support innovative medical care delivery methods designed to lower the costs of health care generally.

Americans with Disability Act (ADA) of 1990
The Americans with Disabilities Act (ADA) of 1990 prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation.

Child Abuse Reporting Contact Information by State
Each state designates specific agencies to receive and investigate reports of suspected child abuse and neglect. This responsibility is typically carried out by child protective services (CPS) within a Department of Social Services, Department of Human Resources, or Division of Family and Children Services. In some states, police departments may also receive reports of child abuse or neglect.

Children's Health Act of 2000
The Children's Health Act of 2000 reauthorizes SAMHSA programs that work to improve mental health and substance abuse services for children and adolescents.

Child Welfare Information Gateway
The Child Welfare Information Gateway provides information pertaining to state statues on child abuse and neglect, child welfare and adoption.

Civil Commitment Criteria and Initiation Procedures by State
This website contains critical state-by-state information about civil commitment laws and criteria for inpatient and outpatient treatment, emergency hospitalization for psychiatric evaluation, and initiating proceedings for court-ordered intervention in a mental health emergency.

Garrett Lee Smith Memorial Act of 2004
The Garrett Lee Smith Memorial Act of 2004 was the first legislation to provide funding specifically for youth suicide prevention programs.

FDA Approved Psychotropic Agents
This site provides an up-to-date list of psychotropic agents.

Mental Health Parity and Addiction Equity Act of 2008
The Mental Health Parity and Addiction Equity Act of 2008 is a federal law that generally prevents group health plans and health insurance issuers that provide mental health and substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical coverage.

Section 504 of the Rehabilitation Act of 1973
Section 504 is a federal law designed to protect the rights of individuals with disabilities in programs and activities that receive Federal financial assistance from the U.S. Department of Education. Section 504 provides: "No otherwise qualified individual with a disability in the United States . . . shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance..."

The Individuals with Disabilities Education Act (IDEA) - US Department of Education
The Individuals with Disabilities Education Act (IDEA) is a law ensuring services to children with disabilities throughout the nation. IDEA governs how states and public agencies provide early intervention, special education and related services to eligible infants, toddlers, children and youth with disabilities. IDEA is composed of six main elements:

  1. Individualized Education Program (IEP),
  2. Free and Appropriate Public Education (FAPE),
  3. Least Restrictive Environment (LRE),
  4. Appropriate Evaluation,
  5. Parent and Teacher Participation, and
  6. Procedural Safeguards.

Landmark Cases
The American Academy of Psychiatry and the Law (AAPL) selected landmark cases, which it considers especially important and significant for forensic psychiatry.

Age of Majority - National Conference of State Legislatures
The "age of majority" is the legal age established under state law at which an individual is no longer a minor and, as a young adult, has the right and responsibility to make certain legal choices that adults make.

Automatic Emancipation

About half of the states do not provide a special court procedure for emancipation, so emancipation can only be achieved automatically, if a minor does one of the following:

  1. Gets married
  2. Joins the Armed Forces
  3. Reaches the age of majority

Statutory Rape - A Guide to State Laws and Reporting Requirements - US Department of Health and Human Services
This is a guide to state laws and reporting requirements pertaining to statutory rape.

US Department of Health & Human Services

Reporting Child Abuse and Neglect
Each State has a system to receive and respond to reports of possible child abuse and neglect. Professionals and concerned citizens can call statewide hotlines, local child protective services, or law enforcement agencies to share their concerns.

Civil Commitment Criteria and Initiation Procedures by State
This website contains critical state-by-state information about civil commitment laws and criteria for inpatient and outpatient treatment, emergency hospitalization for psychiatric evaluation, and initiating proceedings for court-ordered intervention in a mental health emergency.

Seclusion and Restraint Statutes, Regulations, Policies and Guidance, by State and Territory
On July 31, 2009, Secretary Duncan sent a letter to the states and territories urging them to develop or review and, if appropriate, revise their state policies and guidelines to ensure that every student in every school under its jurisdiction is safe and protected from being unnecessarily or inappropriately restrained or secluded. This site summarizes the state and territorial policies regarding seclusions and restraints that resulted from these discussions in order to share information that will help protect all students.

US Department of Education

United States Government Accountability Office (GAO)-Seclusion and Restraints
In 2009, the US Government Accountability Office (GAO) testified before the Education and Labor Committee in the US House of Representatives regarding allegations of death and abuse at residential programs for troubled teens.

Child Custody Laws by State
Most legal matters involving the family are governed by state law, and child custody is no exception. Depending on the state, unmarried (or divorcing) parents have a few different options available for how they would like to arrange custody, ranging from sole custody to joint custody.

Child Passenger Safety Laws

All states and territories require child safety seats for infants and children fitting specific criteria, but requirements vary based on age, weight and height. Often, this happens in three stages:

  1. Infants use rear-facing infant seats;
  2. Toddlers use forward-facing child safety seats; and,
  3. Older children use booster seats.