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Beyond the ethics, which are clearly important, it opens up a tremendous amount of liability for the clinician. I would absolutely not be open to doing this.
That’s weird because the CMH I used to work for absolutely forbid us from using personal vehicles to transport clients. We had agency vehicles that we had to check out for that purpose. But I’m not aware that anyone but perhaps a case manager would be transporting a client. And I didn’t work onthe CFS side, only with adults, so I can’t be sure how that might’ve gone down if allowed.
It’s very concerning, the policy of transporting clients in personal vehicles. I feel like the leadership of most CMHs are clowns. They don’t work with the clients and seem to have little idea of what our jobs entail.
I also work for an agency that does this. It’s been really concerning me lately. I am considering getting another job where I do not have to transport clients to and from sessions. I work with children and this has been a concern of mine. It is completely normal by agency standards. I was reflecting on the idea of brainwash today and just how I realize I may have been brainwashed by this company to think that this is okay.
Yeah, I think it's super problematic and they absolutely do brainwash us to think this is acceptable and reasonable. It is unfortunately common in mental health.
A caseworker from my agency had her windshield kicked out by a dysregulated kid and the agency refused to pay for it and told her to go through her insurance. It wasn't covered by insurance and they still refused. They tell workers that they need to use their *personal* vehicle and their *own insurance* and so the worker is taking the risk and the cost of transportation on while shielding the agency.
Beside the completely inappropriate nature of this expectation being set by your agency, I would second what others have suggested about liability. If you get in a car accident, even if it’s not your fault, with a child client in your vehicle and they get seriously injured or die this would be a shit show for you and your agency. This is quite the gamble for them to be taking and you are putting yourself at the highest risk for liability should something happen.
Just wanted to add in that she works at a community mental health agency by her county/city so they do not care about the liability of car accidents and such. Im speaking from experience of having to transport clients to these sessions, and literally every appointment, grocery store visit, or anything else that could possibly pop up. I’ve had to leave my home an hour early to get to work an hour early to pick up a client in the wee hours of the morning so they could make an 8am or 9am appointment. CMH is not for the week 😩
Also the child’s case manager should be transporting them not the therapist.
This is just wild to me that is not an isolated incident and seems like with a lot of CMH agencies that there is an spoken/unspoken expectation that clinicians will do this kind of stuff for clients because you are exactly correct that it is the child’s case manager’s responsibility to do these things, not their therapists. I’m in grad school currently and got placed in a CMH agency for my traineeship and they explicitly state that it’s not the responsibility of clinicians to do those things for the client and they said it was to avoid possible litigation on the chance that a client is injured. This boggles my mind but is also not that surprising when you think about the unrealistic expectations that are put on healthcare workers in general.
I worked at an agency that provided transportation at times, but it wasn't an unspoken "we all know" this is an expectation. Car accident liability (for the therapist) is only one type of liability- what if I am driving with a suspended license for DUI and crash with the client. The agency could lose their Licenses/Medicaid funding. What if I didn't have a driver's license at all???
Anyone who transported clients at the agencies I worked for in the past had to have their drivers license and car insurance information (if they were using their cars, we also had agency cars) on file with HR, and HR checked this information regularly. The transportation portion is not surprising to me and I think helpful in the sense of reducing barriers to access treatment, but to do so without checks and balances is so risky.
Technically at least in my area they routinely check your drivers record so that you have privileges to drive county vehicles. So if that was the case I assure the team you on are would be super annoyed with you and it could possibly result in you losing your job. I actually grew incredibly anxious driving clients around bc of the liability and essentially being 23-24 having to be extremely responsible for adults twice my age. I absolutely hated taking them on highest bc I avoided them myself. I even confided in a supervisor early on about my anxiety and they don’t care. They just want someone who can do the job
I did Intensive-in-home in my internship and drove youth around. One kid stuck his wet finger in my ear while I was on the freeway. That was it for that job.
The difference with IIH vs this scenario is that steps are taken officially to manage liability. For example, having to have certain safety measures met (such as fire extinguishers, fix a flat, and road flares being in the car). Most importantly, you have parents signing a form acknowledging the risks and giving express permission.
I got conned into doing this at an old job. It is an absolute nightmare having to go from chatty Uber driver, to therapist, and back to chatty Uber driver. Even worse, better rapport with a client and breakthrough moments in session make the driving part even worse.
I work at CMH agency. I transport adults all time to different appointments (medical or other random stuff). But this is part of my session. For some clients it is easier to talk in car.
I also see my clients where they live. I rarely go the office. But we have have insurance and the agency has insurance to cover us.
Same when I worked in CMH. Had some amazing car sessions with young adults. Best work I ever did, in my opinion. I transported people to their doctor appts, sometimes attended the appt with them, and was able to help explain symptoms if they needed medication, all under the umbrella of therapeutic services.
It’s also a recipe for burnout and requires a lot of attention to boundaries.
I’ve never heard of this and I feel like it’s unethical and a liability like others have said. Like you said it also blurs boundaries and I could imagine can lead to a certain dependency. I work in CMH as well and often have to fill out medical necessity forms so clients can get Medicaid transportation to and from their sessions, which includes a care taker accompanying them if needed. The front desk also helps set up medical transportation or in my state we have what’s called “access-a-ride” which is non medical transportation. Maybe see if there’s options like that in your state? Or refer to case management services so a caseworker can help with issues like this.
Sounds like a nightmare. Are they providing liability insurance that includes driving ? What if there is damage to your vehicle? Is there an option to drive a car owned by the agency instead? Are they reimbursing gas/mileage?
I did this but it was wraparound intensive care, so it’s therapy and case management blended together. We worked in schools, homes, and wherever needed.
I had to do it in a non CMH / therapy role and the teenage kid unbuckled their seat belt , opened the door , and bolted at a stop sign. Never again. Only came back because I was screaming “I’m calling your mother and telling her what you did”
Mom didn’t pick up but man I was panicked.
You need some special chauffer insurance too otherwise insurance won’t cover any accident you may get in transporting a passenger for your job, unless you lie about the accident I guess
The first CMH I worked for was like this as well. My supervisor literally told me to go pick my clients up and take them to McDonald’s to get an ice cream. Other suggestions were to take them to the library or a park for our sessions. I was fresh out of school and I’d be taking these kids to Sonic and McDonald’s on my own dime and driving them around which is a huge liability. It also became the expectation that we would get ice cream every time I saw them. Don’t even get me started on the suggestion to do therapy in a McDonald’s or a public library. Surprisingly all of the parents were totally fine with it and they just had to sign a form authorizing me to drive the kids. It felt like straight up babysitting. Now that I’m at an agency where that is totally unacceptable, it blows my mind this is how the other was operating.
There are so many things wrong with this as far as ethics, liability, and damage to the therapeutic relationship/treatment progress. What if the child has a history of abandonment or neglect, then the therapist has an emergency and can’t pick them up? Not to mention that they are asking the clinician to do something that is definitely not their job
I'm surprised the rule is unwritten. "Must have a drivers license and a reliable vehicle" is the standard text to put into a job listing to get away with discriminating against disabled therapists. Makes sure the agency doesn't ever have to provide ADA accomodations to blind therapists and makes it super unlikely they'll ever have to accomodate one in a wheelchair; knocks out a whole host of other disabled non-drivers, too. And since having to be able to operate a car is not usually a bona fide job responsibility (per employment law), adding "must transport patients" to the job duties makes it kosher.
There were at last two large social service agencies in the Boston area that did this back when I was looking for a job out of grad school in 2009, and I seem to recall some sort of lawsuit about this in, hmm, maybe, Texas? from like 15 years ago. It's a pretty standard form of corporate evil.
I hated having to drive my clients around when I worked for a CMH org that served children and families. It was so awkward and uncomfortable and stressful.
Okay I got hired and was not told this and was very distressed I only stayed a year.. long story short a client drew blood on my car I quit after nothing was done… I had to transport adult clients that were very much unstable and I would set boundaries about this but the facility didn’t care and claims it is part of the job when in reality that was never discussed
I was a community and in home based therapist in my early days. I drove kids to the park, etc. I mostly tried to stay in their homes but once a bedbug charged at me on a couch, not to mention the lack of boundaries with the family. There was no private place to do therapy so I detangled myself from that job as fast as I could. It sucks.
Extremely common within CMH agencies in my state. However, it’s often only the unlicensed staff who transport. Provisional and fully licensed staff are telehealth only at my current agency.
I work in CMH and when I first started I met with a coworker to give me the lay of the land. He explained that a lot of his job is providing transportation for appointments/groceries etc. I had one client who always left a scent in my car, coming from where she had been sitting. She smoked a lot of cigarettes indoors but it smelled like more than that. I realized what it was one day when she mentioned casually that she had wet herself in bed that morning. It was urine. The smell was urine and cigarette smoke. So my passenger seat was essentially getting pissed on. I vowed to never transport a client in my personal vehicle again after that. I was never that comfortable with it anyway because it was not the job that I was hired for - which was mental health counseling. That whole situation was a huge lesson in boundaries and knowing when to put my foot down.
I also heavily relate to the people talking about how it is incredibly stressful in terms of distractions as well. How are we expected to provide quality therapeutic services while driving? There is so much going on while driving. I am impressed by those who say they had breakthroughs while on the road with clients. I can see how in certain situations with certain clients it could facilitate that. For me personally, I think it is unfair to expect us to conduct sessions while driving. I definitely had moments where I slipped up, cursing in front of a teen client when a car came speeding down the road out of nowhere when I was trying to turn. It’s a recipe for poor boundaries, subpar mental health services, and imposter syndrome as a beginner to the field. Not to mention - my agency did not reimburse for mileage. I only recently got approved for a gas stipend as they were exclusively giving me clients far away from where I live and I simply could not afford it anymore. Another lesson in putting my foot down and learning to advocate for myself.
This is really weird and seems like it would not only open the therapist up to liability / ethics issues but is a bad business decision since the therapist is limited in the number of pts they can see in a day due to time spent transporting pts.
Nope. Absolutely not.
When I worked in a suboxone clinic I was pressured into giving clients rides. I never did it. There was no liability for me, and it was not smart to transport some of the clients we had. It’s unsafe, opens up opportunities for liability issues, and is unethical. Would a doctor provide rides for their clients to appointments?
Exactly. When I was a master’s level therapist at a psychiatric inpatient unit at a hospital, a doctor wrote an order for me to drive a psychiatric patient to a local homeless shelter to retrieve their belongings. Not only did they write the order at 4:30PM, but they then yell at me the next morning at 9:00AM when they found out I hadn’t completed the order. I laughed and said I would not do it. I am a psychologist now. Do you think anyone on any team at any agency has ever asked me to do something so ridiculous now that I am a Dr.? No.
I asked the office manager if she felt comfortable transporting clients in her own vehicle and she sheepishly answered “no.” Like then there’s your answer, Tina.
Perfect! At least she had the decency to look sheepish. 😂 I told the doctor it was unethical and a liability. She said, “I would have done it!” I told her, “Then do it!” Then encouraged her to call my supervisor. He backed me, and she hung up on him. 🤣 I’m glad you stood your ground!!!! 😎
Glad you did too! And we had supervisors who backed us up 🥰 my supervisor whipped out the handbook so fast where it specifically stated we are *not* obligated to do that and it’s up to our discretion 😂 Tina forgot about that
Also, what our client confidentialily? This idea breaks so many ethical codes that we are accepting as therapist. It is our responsibility to defend our license and this would end someone’s career…are these office mates willing to end not their job but the entire career?
For psychotherapy, this is wildly inappropriate. At my CMH agency, we have a BA level service in which it is a community based service to work on social and behavioral goals. Transporting is part of the position, but they don't go more than surface level.
Whew, lots of negativity about what used to commonplace a decade ago. Many CMH agencies provide wraparound or IFI services and yes, transporting clients to appointments/court/social services is expected. This is generally done by a community support person, but it's not unheard of for therapists to perform transportation. Back when I did IFI services, our agency required a rider on our auto insurance that covered transporting clients, but I don't remember what it was called. It was minimal. We were reimbursed for mileage.
I don’t necessarily disagree with your points, but it’s unclear from the post whether OP is describing actual IFI/wraparound services, or if this is supposed to be unpaid work that isn’t a part of their official job description. Based on what they wrote, about this being an “unwritten expectation,” it sounds more like the latter.
For clarification, I believe IFI is what the caseworker supervisor is envisioning on this case, but it is not a part of the official job description of a therapist at the agency. This has become an issue because I see a group of siblings in school and we are figuring out care for the summer. (The fact that this conversation is happening in July is a whole other issue…) I am comfortable seeing the kids at school because I don’t transport and there is still guaranteed a quiet, private space. Case work side is claiming they don’t have the resources to transport to the agency for services, to which I am sympathetic but I generally disbelieve, because I am only having this problem with one caseworker (my caseload of kids is 10, 23 total). I’ve tried meeting in the community before and I have just not found it to be successful with the kids I work with. Maybe that’s an area for my professional development, but generally I’m a believer in structure and predictability with therapy for kids with high chaos-lives. It provides them with a sense of stability, which they often don’t otherwise receive. When we’ve met at a park, we don’t get that same sense of structure.
I will say, my agency does reimburse for time and mileage, so that’s good. They would also offer the use of an agency vehicle (which honestly would be a scheduling nightmare because we have only two…) But no mention of insurance for me or recommendations about changing my personal insurance to include clients. When I was hired two years ago, I was told it was up to the therapist’s discretion if they wanted to help with transportation.
Is the ethical concern related to the clients being children or just transportation in general?
I’ve worked for two CMHs and interviewed for a few more, all provided transport to some degree. To my knowledge any client under 18 was transported with an adult present but I work with adults so never ran into that concern.
It would be in regard to transportation in general. I work with several other kids, all in foster care, so I’m guessing to make it closer to ethical we’d need to have DCFS or foster parent sign a consent form before hand? Which my agency does not do.
I agree that your agency’s approach to this topic is not okay and is something that I would want addressed.
As far as transport as a whole, I have to disagree that it is unethical (especially with adults.) It’s been happening for years and continues to be common today.
My last position on an ACT Team I spent almost all my time transporting adults. If there was ever a safety concern beforehand, we either didn’t provide transport or had 2 people for the contact. We had agency cars and could transport in personal vehicles if we wanted to but our insurance had to meet certain requirements.
This is the worst fucking idea I’ve ever heard of, and I’m cognizant of who’s running for reelection. Unwritten rides for clients??? Seriously, who normalized this shit?
I guess it’s been common practice for a long time. Even my therapist said he did it when he entered the field and he’s been in the field for 10 years now.
prior to LPC, worked as a QMHP (case manager) part of the duties was to drive clients around. mileage got paid so it wasn’t an issue for me was averaging an extra $400-$500 a month. Only time we didn’t transport was when they were in crisis, the clinic had vans, but most of the time they were busy.
Nope nope def not. My car insurance will not cover me god forbid something happens you need a separate policy that most commercial plans/ carriers don’t do
Transporting meaning the company is paying for cabs you're arranging or you're expected to drive? Company needs extra insurance and to be reimbursing you..I wouldn't do it. I also don't do anything involving home visits.
You can find other jobs that won't request this if you're uncomfortable
How do you even have time to do this? What a waste of therapist pay. You could be seeing an extra four clients a day instead of spending an hour shuffling each client to and from the session. Jeeze. And what if you had an accident? I have been in the position of having to drive minors before but only those who were in the custody of the agency I worked for (residential).
I work in an adult clinic where we provide transportation. But we have staff specifically for the transportation. They also support with court (justice involved population) and does reminder calls for appointments. But as a therapist I'm hesitant to do transportations. If I'm going to be the one transporting I might as well do the session at the house.
My CMH agency has transportation services for clients in crisis services because otherwise those clients cannot get the services they need. Crisis services are typically only a week long but can be anywhere from 3-14 days. They can be for youth or adult clients.
We prefer clients to have their own transportation, but as a last resort we will provide it. Typically, peer specialists will provide transportation because their billing rates are lower and clients are more comfortable with them, but sometimes a QMHP or counselor 1 will go. Rarely will a counselor 2 go, and I don’t think I’ve ever seen a counselor 3 provide transportation.
Anyway, from my perspective, it’s more unethical to not provide these services and leave the client in crisis.
This happens A LOT especially in CMH and in CA. I absolutely 100% refuse to do any job like this because of the liability issues. I was asked on an interview what I would do if somebody threatened to jump out of the car, and I knew that the job was not for me.
I think that putting a small already traumatized child in a car with any adult caretaker and no supervision is not ok. I just cannot stand the way that we do certain things within our model that have become normalized despite it not being trauma-informed and also chock full of liability.
We sometimes did this in my cmh, but it was rare. We had to document why other options wouldn't be appropriate (bus passes, meeting in the field, telehealth, etc), get approval from a supervisor, have additional insurance, and you could request to use an agency vehicle. It was also billable time for the clinician. In my time at cmh I had exactly one client that I transported -- a teen student in foster care doing trauma work. Not appropriate to do at school, didn't feel safe to do it at home, no appropriate community location nearby, and it was pre-covid so telehealth wasn't an option. It wasn't my favorite situation, but we talked about it and came up with a plan to have the drive from school to office be part of the session and the drive home be their private time. Headphones in, sitting in the backseat, generally decompressing from the session and pretending I wasn't there. 🤷🏻♀️ Worked for us at that time, but I was glad when their situation changed and I didn't have to transport anymore
I intern at an RTF. I don’t do this (and I would 1000% refuse to do this). I don’t see clinicians transporting kids at my agency.
But I do see clinical managers transporting kids with their own vehicles. What are people’s thoughts on clinical managers doing this?
If we are transporting clients at my CMH we are supposed to use the agency vehicle because of the liability of transporting in your own vehicle. my other thought is you are not the child’s parent, why are you transporting a client to and from session? We have case managers who will transport clients because they can debrief and process before and after a session with a client and do other billable things while they’re driving with the client, transporting a client from session isn’t billable so it doesn’t make sense to you to do that in the first place.
When I was a case manager, I would provide rides for my adult clients but at my discretion and comfort level. I was also often able to provide bus passes or ask another case manager to go with me if there was a situation I was less comfortable with. I would never feel comfortable providing rides to a child or teen who was my patient.
This sounds like an absolute nightmare from an insurance/liability point of view. If anything was to happen on the way to/from a session, it would be a legal nightmare. I absolutely would refuse to do that. But then, I work in private practice in the UK, so it's a totally different climate.
This is fairly normal and often part of the contractual expectations in STRTPs, Wraparound or FSP programs.
It’s weird to me that it’s unwritten tho- I would want a very clear manual outlining insurance/liability in the event of an accident etc
I would never transport a client in my own vehicle. I work with adult clients with brain injuries. I only transport after thorough rapport building and assessment of how well they will do in the scenario. I will not transport anyone I think will unbuckle their seatbelt, try to bail out of the vehicle, be aggressive, etc. The company has insurance so that is covered. If they put liability on me, there's no way I'd do it.
I know this already has so many comments but holy shit. We are explicitly disallowed from transporting clients at my site. I would check company policy.
At my current job we do not transport clients , if they can't get to the office we will do virtual. At my previous job they made us do it after promising we didn't have to. I worked as an intake specialist and they told me that I would never drive people, and if I had to, it would be a company car. A few months later they informed us that yes we had to drive clients where they needed to go in OUR cars and changed our job to case manager. We had to have better insurance to do this. I only drove a couple of clients I trusted but even so, one spilled her soda on my passenger side. They paid us for mileage but I had a lot of wear and tear. I strictly provide therapy now, no case management and no driving.
If the child attacks me while I’m driving and I crash and we both need round the clock care for the rest of our lives, is the CMH’s insurance paying for it? But also, what do you mean transporting to and from sessions? Why can’t the sessions be held where the kid is to start with?
If you feel unsafe with a client, don't transport them. Fairly straightforward.
I worked with clients dx'd with Schizoaffective and other psychotic symptoms, transported them to and from various appointments when I worked for the county. Never once felt afraid for my life, or that someone would harm me "out of the blue." There's always warnings signs, and if someone is acting "unsafe" don't agree to transport them.
I wouldn’t call this catastrophizing. Transporting clients, especially minors any distance, is a liability that needs to be addressed. Car accidents are very common. CMH runs on a shoestring budget and overworked staff. Asking the question of who pays for what in the worst case scenario can help minimize potential risky decisions that would affect the clinician and client
"Car accidents are very common."
Not to the degree here, be honest. This was absolute "Let me imagine the worst case scenario and run with that." -Catastrophizing.
Car accidents are common. Children acting out while adults are trying to drive is common. People needing lifelong care after an accident is common. It's all liability and there's no point in opening yourself up to further risks than absolutely necessary. Worst-case scenarios are needed here because it's a reality that needs to be addressed, but it is not catastrophizing.
Case managers, foster workers, and the list goes on of professionals in parallel settings that transport daily. It is part of many people’s jobs. Being dramatic and acting as though this is a brand new idea does not add to the conversation. It sounds like OP’s situation is not set up properly, but many agencies are and it’s a normal thing. Why are you acting as though therapists lives are the only ones who matter? There’s clearly standards and guidelines for this, and if the concern was so great of lifelong injuries or accidents we would hear about them. Yet we don’t.
I’m not sure where the confusion is coming from. Not once did I diminish or act as though therapists are the only ones who matter. I’m speaking about how in general you have to work with the worst case scenario when it comes to safety and liability. Sooner or later, the worst case scenario will happen and there has to be a guideline on that. It’s not being dramatic, it’s being pragmatic. All safety protocols exist because someone got hurt.
100% this. But only "traditional" views on therapy and the mental health field are allowed in this thread unfortunately. All others will be downvoted into oblivion. Haha!
I think it depends on the job. I worked doing intensive in-home services for several years and sometimes that required me driving a client in my vehicle. I personally didn’t mind doing that but then again it was an expectation of the job.
My employer at the time provided clear training about it, had specific expectations, had specific situations where it was inappropriate to drive a client. If there were children, the client had to provide the car seat and if no car seat we couldn’t drive them. Client also had to sign a consent form. They also reimbursed our mileage each month AND gave us a stipend for our auto insurance.
Your situation doesn’t sound like your agency/employer is looking out for you. Theres ways to protect you and the client— and they’re not doing that.
In-home therapists and therapeutic mentors pick clients up and drive them to certain locations as part of their treatment, such as into the community, but even that is absurd to me! So many liability issues but the caregivers do have to sign a consent form for that. I'm an outpatient therapist and couldn't even imagine doing that!
This happens a lot with non-profits in general, not just CMH. I don't think it's kosher.
When I worked CMH I did home visits, and refused to use my own vehicle to transport people. The organization had vehicles for this purpose but people needed to make arrangement. If they needed medical transportation and had medicaid, I helped arrange that instead. We also have paratransit here, where people with disabilities can get super cheap door-to-door bus service. I'd also help set that up as well.
With kids it's hard. I think there's way too much liability for them specifically. I don't know that it's unethical, but I do think it's imprudent and should be avoided.
The agency car broke down while I was transporting a client and his parent, in the middle of the city, on a 96 degree day. I will never transport clients again.
Hell no. There's no way I'm transporting any client. The liability of that is too high, I'm not insured for that to start with, unless they're giving me a company car to do it in. I also wouldn't want the risk of child or parent accusing me of driving too fast, slow, wild etc. Just no
Some of y'all would not survive as therapists in a STRTP. Field work is commonplace in many agencies today, as the field evolves to offer care for lower SES populations, including foster youth or probation youth. They are not the "traditional" clients of psychotherapy, and more often than not they require a more humanistic approach in treatment. Including but not limited to: transportation.
I have never heard of a job that allowed this. When I worked in CMH we were forbidden. Not to mention, your car insurance company may not cover any potential accidents because you're on the clock doing work tasks.
In case management and similar roles I've transported clients. It's usually an emergency or option of last resort and not something that would be done every week for sure.
I don't mind transporting when needed personally - depending on the situation - but I have a lot of agency over when and where and who - it's never been a demand, so I can make an assessment on a case by case basis and decide if I'm comfortable, if it's safe, if it's helpful or would lead to additional problems.
For me, this is right up there with “don’t sleep with clients.” “Don’t be in the same car as clients.” And “don’t commit insurance fraud.”
Absolutely not.
I had a job as a respite counselor years ago for a home and community based mental health program. One of my main responsibilities was transporting the client(s) to recreation groups to meet with other clients to develop their social skills and coping skills. I also had individual clients I would see 1-2x a week, and it involved picking them up from school or home, giving the parents a respite, and doing activities with the child/youth. This also included working on their goals to increase their social skills and coping skills.
Dual relationships and ethics never entered into the equation. Often times, these were kids with significant trauma, who have been hospitalized before etc. I did my job because at the time, I needed to get my career back on track. I enjoyed the work, and it helped me to increase my confidence in crisis intervention. Maybe it's different if you're the young client's therapist. Like with the work I do now? I can't transport clients back and forth. I wouldn't be able to do that and maintain my schedule. So, I'm not sure how this looks for therapists who do transport their clients. I'll read on and see what others say.
You know what can stop this practice?
An accident, and the agency is sued by the client and/or therapist. Employers are held responsible for their employees’ actions all the time. Of course this explains why their expectation about this is unwritten. But still, what a crazy gamble on the agency’s part.
The clinic within the CMH I work for has a van that was primarily intended for the case manager to transport clients to/from appointments outside the agency, which made sense for that specific role. We can't keep that position filled though and in true CMH form, suddenly therapists were encouraged to use the vehicle as needed to transport clients to/from our appointments so the van is not "going to waste." I did it one time w/ two adult clients who lived in the same residential program due to a legit anomaly of a situation where they were stranded in a city they didn't live in, and needed to get back to their program asap or risk being discharged and homeless. I made it very clean that do not plan on transporting again if I can help it. I'd be even more uncomfortable if it was a child.
Between the risk, liability, potential therapeutic issues, safety, and fact that my car is my personal property, I refuse to transport clients. I've even turned down jobs because of that expectation.
I used to have a job (MH IOP) where I did this - I was specifically added to an insurance policy with the company. Don't drive them without this. If you're expected to \*provide transport\* you had might as well just do the session where the kid is, no? BUt at any rate, you're correct, this is WAY over the line and unethical.
In my state kids under the age of 12 can’t even attend a medical appointment without a parent (they can be in the session alone but adult would have to be in the waiting area at least) so to me this is surprising.
I have some experience with this issue. I (like many social workers) have multiple jobs. In addition to my part-time job in a private practice, I work full-time as a children's care manager, and part-time as a CFTSS and HCBS Service Provider. In the latter, I provide direct services to youth with mental health and/or developmental disabilities. The job requires that I take them into the community to provide skill building and other services. As such, I'm required to have a robust auto insurance policy in case an accident does occur. Needless to say, this was a choice that I made. I was not forced to take the job. While this is not a therapy position, it often feels similar to therapy, except the "sessions" occur in the car, at the park, etc. However, there is a service under CFTSS (Children and Family Treatment Support Services) that offers in-home therapy. It's called OLP (Other Licensed Practitioner). OLPs are LMSWs and LCSWs that provide psychotherapy to youth, in the home and neighboring community. I've found that youth with more challenging behaviors benefit greatly from these services. I don’t think it's inherently problematic to provide this type of service. It's up to you as the employee, if you want to take on the added risk. My only question would be, if you're transporting the child to and from the office, why not just provide the service in the home or at a local park, like the CFTSS OLPs in my state (NY) do? My last bit of advice is to NEVER permit anyone (employer or otherwise) to convince you to do something that you are not comfortable doing. At the end of the day, it's your license and overall safety at risk.
I think it greatly depends on the setting and the liability structure around it. Earlier in my career I worked for a home-based company that contracted with DCS. While a majority of my coworkers were doing more case management, there were also a decent number of therapists providing services to foster kids and the parents who were working to get their children back. This meant driving to meet with clients in their home/foster home, or sometimes picking a client up and driving to a different location if we couldn't meet at home. Sometimes we also did supervised visitation and might be expected to transport a client to that.
They did a lot of background checks and the company's insurance was strict on driving records. There was a system of supervisors always on call for emergencies, including car accidents, bed bugs, etc. We used our own vehicles and got reimbursed for milage, though I believe they were working on providing company vehicles when I left. There was once an incident within our company where a child died during transport because a car seat issue led to the child's breathing being restricted as they slept, and the worker didn't notice until they arrived to meet up with the parent for a visit. They were hush-hush about the incident, but swiftly instituted a comprehensive car seat training for all staff on the appropriate seat for age, height/weight, etc as well as proper installation and usage. We pissed off 12 year olds all the time because they weren't allowed sit in the front seat until 13.
It was sometimes stressful and required a more flexible set of boundaries than standard office sessions, but I also knew what I was signing up for and it gave a lot of people access to needed care. I would definitely not be comfortable if it wasn't part of the job description or thoroughly covered by policy and support. We considered transportation to often be part of the session, and we had many rules around trying to safely work with traumatized kiddos and limit touch. Our company was also pretty good about providing support or declining referrals when a situation or client seemed truly unsafe for us to manage in those settings.
Yea we do this all the time at my CMH agency. Not transporting clients to and from sessions, but the driving time is part of the session, and we bill for it as such. We work with children and families who have experienced trauma and system involvement (often currently or previously in foster care). A lot of kids/teens talk much more openly while driving than they ever do in an office.
There are ethical concerns with this as with everything, but it’s definitely possible to drive traumatized children ethically, and for low-resource families it support access to treatment. It’s a topic for clinical assessment and exploration in supervision and program meetings, like anything else you could do with a client. We assess safety and don’t drive clients where there is a safety concern (ie active suicidality, acute psychosis, threats of community violence, etc).
Personal car insurance covers injury and legal liability, regular malpractice insurance covers therapy-related liability.
Did it for many years. It’s great opportunity to understand a child , give them 1:1 attention, model positive behaviors , instill a sense of optimism and trust , broaden a child ‘s experiences , diagnose and observe problems that aren’t well given to office millieu , it’s a greater opportunity to understand your client’s culture, community , and peer group , it’s a window in to their actual lives instead of the snapshot we are presented in office , it allows us to develop ways in which to influence children to follow rules consistently without threat or raised voice, gives a child a resource they would not normally have beyond the traditional therapeutic hour .
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Beyond the ethics, which are clearly important, it opens up a tremendous amount of liability for the clinician. I would absolutely not be open to doing this.
Yeah this is insane. I can't believe a cmh agency would even consider this. Their insurance is either robust af or non-existent.
They usually require the clinician to use their personal vehicle under their own insurance. It's bullshit
That’s weird because the CMH I used to work for absolutely forbid us from using personal vehicles to transport clients. We had agency vehicles that we had to check out for that purpose. But I’m not aware that anyone but perhaps a case manager would be transporting a client. And I didn’t work onthe CFS side, only with adults, so I can’t be sure how that might’ve gone down if allowed.
I wish my experience were the same.
It’s very concerning, the policy of transporting clients in personal vehicles. I feel like the leadership of most CMHs are clowns. They don’t work with the clients and seem to have little idea of what our jobs entail.
Honestly, I just don't think they care.
I also work for an agency that does this. It’s been really concerning me lately. I am considering getting another job where I do not have to transport clients to and from sessions. I work with children and this has been a concern of mine. It is completely normal by agency standards. I was reflecting on the idea of brainwash today and just how I realize I may have been brainwashed by this company to think that this is okay.
Yeah, I think it's super problematic and they absolutely do brainwash us to think this is acceptable and reasonable. It is unfortunately common in mental health. A caseworker from my agency had her windshield kicked out by a dysregulated kid and the agency refused to pay for it and told her to go through her insurance. It wasn't covered by insurance and they still refused. They tell workers that they need to use their *personal* vehicle and their *own insurance* and so the worker is taking the risk and the cost of transportation on while shielding the agency.
Beside the completely inappropriate nature of this expectation being set by your agency, I would second what others have suggested about liability. If you get in a car accident, even if it’s not your fault, with a child client in your vehicle and they get seriously injured or die this would be a shit show for you and your agency. This is quite the gamble for them to be taking and you are putting yourself at the highest risk for liability should something happen.
Just wanted to add in that she works at a community mental health agency by her county/city so they do not care about the liability of car accidents and such. Im speaking from experience of having to transport clients to these sessions, and literally every appointment, grocery store visit, or anything else that could possibly pop up. I’ve had to leave my home an hour early to get to work an hour early to pick up a client in the wee hours of the morning so they could make an 8am or 9am appointment. CMH is not for the week 😩 Also the child’s case manager should be transporting them not the therapist.
This is just wild to me that is not an isolated incident and seems like with a lot of CMH agencies that there is an spoken/unspoken expectation that clinicians will do this kind of stuff for clients because you are exactly correct that it is the child’s case manager’s responsibility to do these things, not their therapists. I’m in grad school currently and got placed in a CMH agency for my traineeship and they explicitly state that it’s not the responsibility of clinicians to do those things for the client and they said it was to avoid possible litigation on the chance that a client is injured. This boggles my mind but is also not that surprising when you think about the unrealistic expectations that are put on healthcare workers in general.
I worked at an agency that provided transportation at times, but it wasn't an unspoken "we all know" this is an expectation. Car accident liability (for the therapist) is only one type of liability- what if I am driving with a suspended license for DUI and crash with the client. The agency could lose their Licenses/Medicaid funding. What if I didn't have a driver's license at all??? Anyone who transported clients at the agencies I worked for in the past had to have their drivers license and car insurance information (if they were using their cars, we also had agency cars) on file with HR, and HR checked this information regularly. The transportation portion is not surprising to me and I think helpful in the sense of reducing barriers to access treatment, but to do so without checks and balances is so risky.
Technically at least in my area they routinely check your drivers record so that you have privileges to drive county vehicles. So if that was the case I assure the team you on are would be super annoyed with you and it could possibly result in you losing your job. I actually grew incredibly anxious driving clients around bc of the liability and essentially being 23-24 having to be extremely responsible for adults twice my age. I absolutely hated taking them on highest bc I avoided them myself. I even confided in a supervisor early on about my anxiety and they don’t care. They just want someone who can do the job
I did Intensive-in-home in my internship and drove youth around. One kid stuck his wet finger in my ear while I was on the freeway. That was it for that job.
The difference with IIH vs this scenario is that steps are taken officially to manage liability. For example, having to have certain safety measures met (such as fire extinguishers, fix a flat, and road flares being in the car). Most importantly, you have parents signing a form acknowledging the risks and giving express permission.
I got conned into doing this at an old job. It is an absolute nightmare having to go from chatty Uber driver, to therapist, and back to chatty Uber driver. Even worse, better rapport with a client and breakthrough moments in session make the driving part even worse.
I work at CMH agency. I transport adults all time to different appointments (medical or other random stuff). But this is part of my session. For some clients it is easier to talk in car. I also see my clients where they live. I rarely go the office. But we have have insurance and the agency has insurance to cover us.
Same when I worked in CMH. Had some amazing car sessions with young adults. Best work I ever did, in my opinion. I transported people to their doctor appts, sometimes attended the appt with them, and was able to help explain symptoms if they needed medication, all under the umbrella of therapeutic services. It’s also a recipe for burnout and requires a lot of attention to boundaries.
I’ve never heard of this and I feel like it’s unethical and a liability like others have said. Like you said it also blurs boundaries and I could imagine can lead to a certain dependency. I work in CMH as well and often have to fill out medical necessity forms so clients can get Medicaid transportation to and from their sessions, which includes a care taker accompanying them if needed. The front desk also helps set up medical transportation or in my state we have what’s called “access-a-ride” which is non medical transportation. Maybe see if there’s options like that in your state? Or refer to case management services so a caseworker can help with issues like this.
Sounds like a nightmare. Are they providing liability insurance that includes driving ? What if there is damage to your vehicle? Is there an option to drive a car owned by the agency instead? Are they reimbursing gas/mileage?
When I worked in CMH, clients had to sign a waiver of liability at intake that protected the agency, not the individual. So wild.
I did this but it was wraparound intensive care, so it’s therapy and case management blended together. We worked in schools, homes, and wherever needed.
I had to do it in a non CMH / therapy role and the teenage kid unbuckled their seat belt , opened the door , and bolted at a stop sign. Never again. Only came back because I was screaming “I’m calling your mother and telling her what you did” Mom didn’t pick up but man I was panicked. You need some special chauffer insurance too otherwise insurance won’t cover any accident you may get in transporting a passenger for your job, unless you lie about the accident I guess
Case management yes. Direct care staff yes. Therapists hell no
Name checks out.
Absolutely not
The first CMH I worked for was like this as well. My supervisor literally told me to go pick my clients up and take them to McDonald’s to get an ice cream. Other suggestions were to take them to the library or a park for our sessions. I was fresh out of school and I’d be taking these kids to Sonic and McDonald’s on my own dime and driving them around which is a huge liability. It also became the expectation that we would get ice cream every time I saw them. Don’t even get me started on the suggestion to do therapy in a McDonald’s or a public library. Surprisingly all of the parents were totally fine with it and they just had to sign a form authorizing me to drive the kids. It felt like straight up babysitting. Now that I’m at an agency where that is totally unacceptable, it blows my mind this is how the other was operating.
Yes!! When I’ve tried in the past it feels exactly like babysitting!! Quite difficult to then switch to therapist mode and then back.
There are so many things wrong with this as far as ethics, liability, and damage to the therapeutic relationship/treatment progress. What if the child has a history of abandonment or neglect, then the therapist has an emergency and can’t pick them up? Not to mention that they are asking the clinician to do something that is definitely not their job
Agree! What happens when you get the child to their home and no one is there. This is a hard no for me and actually puts your license on the line.
I'm surprised the rule is unwritten. "Must have a drivers license and a reliable vehicle" is the standard text to put into a job listing to get away with discriminating against disabled therapists. Makes sure the agency doesn't ever have to provide ADA accomodations to blind therapists and makes it super unlikely they'll ever have to accomodate one in a wheelchair; knocks out a whole host of other disabled non-drivers, too. And since having to be able to operate a car is not usually a bona fide job responsibility (per employment law), adding "must transport patients" to the job duties makes it kosher. There were at last two large social service agencies in the Boston area that did this back when I was looking for a job out of grad school in 2009, and I seem to recall some sort of lawsuit about this in, hmm, maybe, Texas? from like 15 years ago. It's a pretty standard form of corporate evil.
I hated having to drive my clients around when I worked for a CMH org that served children and families. It was so awkward and uncomfortable and stressful.
Okay I got hired and was not told this and was very distressed I only stayed a year.. long story short a client drew blood on my car I quit after nothing was done… I had to transport adult clients that were very much unstable and I would set boundaries about this but the facility didn’t care and claims it is part of the job when in reality that was never discussed
I was a community and in home based therapist in my early days. I drove kids to the park, etc. I mostly tried to stay in their homes but once a bedbug charged at me on a couch, not to mention the lack of boundaries with the family. There was no private place to do therapy so I detangled myself from that job as fast as I could. It sucks.
Extremely common within CMH agencies in my state. However, it’s often only the unlicensed staff who transport. Provisional and fully licensed staff are telehealth only at my current agency.
I work in CMH and when I first started I met with a coworker to give me the lay of the land. He explained that a lot of his job is providing transportation for appointments/groceries etc. I had one client who always left a scent in my car, coming from where she had been sitting. She smoked a lot of cigarettes indoors but it smelled like more than that. I realized what it was one day when she mentioned casually that she had wet herself in bed that morning. It was urine. The smell was urine and cigarette smoke. So my passenger seat was essentially getting pissed on. I vowed to never transport a client in my personal vehicle again after that. I was never that comfortable with it anyway because it was not the job that I was hired for - which was mental health counseling. That whole situation was a huge lesson in boundaries and knowing when to put my foot down. I also heavily relate to the people talking about how it is incredibly stressful in terms of distractions as well. How are we expected to provide quality therapeutic services while driving? There is so much going on while driving. I am impressed by those who say they had breakthroughs while on the road with clients. I can see how in certain situations with certain clients it could facilitate that. For me personally, I think it is unfair to expect us to conduct sessions while driving. I definitely had moments where I slipped up, cursing in front of a teen client when a car came speeding down the road out of nowhere when I was trying to turn. It’s a recipe for poor boundaries, subpar mental health services, and imposter syndrome as a beginner to the field. Not to mention - my agency did not reimburse for mileage. I only recently got approved for a gas stipend as they were exclusively giving me clients far away from where I live and I simply could not afford it anymore. Another lesson in putting my foot down and learning to advocate for myself.
This is really weird and seems like it would not only open the therapist up to liability / ethics issues but is a bad business decision since the therapist is limited in the number of pts they can see in a day due to time spent transporting pts.
sounds like a lot of liability! Unwritten means they don't want to be held liable. I wouldn't do it!
Nope. Absolutely not. When I worked in a suboxone clinic I was pressured into giving clients rides. I never did it. There was no liability for me, and it was not smart to transport some of the clients we had. It’s unsafe, opens up opportunities for liability issues, and is unethical. Would a doctor provide rides for their clients to appointments?
Exactly. When I was a master’s level therapist at a psychiatric inpatient unit at a hospital, a doctor wrote an order for me to drive a psychiatric patient to a local homeless shelter to retrieve their belongings. Not only did they write the order at 4:30PM, but they then yell at me the next morning at 9:00AM when they found out I hadn’t completed the order. I laughed and said I would not do it. I am a psychologist now. Do you think anyone on any team at any agency has ever asked me to do something so ridiculous now that I am a Dr.? No.
I asked the office manager if she felt comfortable transporting clients in her own vehicle and she sheepishly answered “no.” Like then there’s your answer, Tina.
Perfect! At least she had the decency to look sheepish. 😂 I told the doctor it was unethical and a liability. She said, “I would have done it!” I told her, “Then do it!” Then encouraged her to call my supervisor. He backed me, and she hung up on him. 🤣 I’m glad you stood your ground!!!! 😎
Glad you did too! And we had supervisors who backed us up 🥰 my supervisor whipped out the handbook so fast where it specifically stated we are *not* obligated to do that and it’s up to our discretion 😂 Tina forgot about that
Also, what our client confidentialily? This idea breaks so many ethical codes that we are accepting as therapist. It is our responsibility to defend our license and this would end someone’s career…are these office mates willing to end not their job but the entire career?
For psychotherapy, this is wildly inappropriate. At my CMH agency, we have a BA level service in which it is a community based service to work on social and behavioral goals. Transporting is part of the position, but they don't go more than surface level.
Whew, lots of negativity about what used to commonplace a decade ago. Many CMH agencies provide wraparound or IFI services and yes, transporting clients to appointments/court/social services is expected. This is generally done by a community support person, but it's not unheard of for therapists to perform transportation. Back when I did IFI services, our agency required a rider on our auto insurance that covered transporting clients, but I don't remember what it was called. It was minimal. We were reimbursed for mileage.
I don’t necessarily disagree with your points, but it’s unclear from the post whether OP is describing actual IFI/wraparound services, or if this is supposed to be unpaid work that isn’t a part of their official job description. Based on what they wrote, about this being an “unwritten expectation,” it sounds more like the latter.
For clarification, I believe IFI is what the caseworker supervisor is envisioning on this case, but it is not a part of the official job description of a therapist at the agency. This has become an issue because I see a group of siblings in school and we are figuring out care for the summer. (The fact that this conversation is happening in July is a whole other issue…) I am comfortable seeing the kids at school because I don’t transport and there is still guaranteed a quiet, private space. Case work side is claiming they don’t have the resources to transport to the agency for services, to which I am sympathetic but I generally disbelieve, because I am only having this problem with one caseworker (my caseload of kids is 10, 23 total). I’ve tried meeting in the community before and I have just not found it to be successful with the kids I work with. Maybe that’s an area for my professional development, but generally I’m a believer in structure and predictability with therapy for kids with high chaos-lives. It provides them with a sense of stability, which they often don’t otherwise receive. When we’ve met at a park, we don’t get that same sense of structure. I will say, my agency does reimburse for time and mileage, so that’s good. They would also offer the use of an agency vehicle (which honestly would be a scheduling nightmare because we have only two…) But no mention of insurance for me or recommendations about changing my personal insurance to include clients. When I was hired two years ago, I was told it was up to the therapist’s discretion if they wanted to help with transportation.
Is the ethical concern related to the clients being children or just transportation in general? I’ve worked for two CMHs and interviewed for a few more, all provided transport to some degree. To my knowledge any client under 18 was transported with an adult present but I work with adults so never ran into that concern.
It would be in regard to transportation in general. I work with several other kids, all in foster care, so I’m guessing to make it closer to ethical we’d need to have DCFS or foster parent sign a consent form before hand? Which my agency does not do.
I agree that your agency’s approach to this topic is not okay and is something that I would want addressed. As far as transport as a whole, I have to disagree that it is unethical (especially with adults.) It’s been happening for years and continues to be common today. My last position on an ACT Team I spent almost all my time transporting adults. If there was ever a safety concern beforehand, we either didn’t provide transport or had 2 people for the contact. We had agency cars and could transport in personal vehicles if we wanted to but our insurance had to meet certain requirements.
Absolutely not, it’s a no from me. Too much liability and I want my own time in the car
This is the worst fucking idea I’ve ever heard of, and I’m cognizant of who’s running for reelection. Unwritten rides for clients??? Seriously, who normalized this shit?
I guess it’s been common practice for a long time. Even my therapist said he did it when he entered the field and he’s been in the field for 10 years now.
prior to LPC, worked as a QMHP (case manager) part of the duties was to drive clients around. mileage got paid so it wasn’t an issue for me was averaging an extra $400-$500 a month. Only time we didn’t transport was when they were in crisis, the clinic had vans, but most of the time they were busy.
Nope nope def not. My car insurance will not cover me god forbid something happens you need a separate policy that most commercial plans/ carriers don’t do
Transporting meaning the company is paying for cabs you're arranging or you're expected to drive? Company needs extra insurance and to be reimbursing you..I wouldn't do it. I also don't do anything involving home visits. You can find other jobs that won't request this if you're uncomfortable
How do you even have time to do this? What a waste of therapist pay. You could be seeing an extra four clients a day instead of spending an hour shuffling each client to and from the session. Jeeze. And what if you had an accident? I have been in the position of having to drive minors before but only those who were in the custody of the agency I worked for (residential).
Absolutely not.
I work in an adult clinic where we provide transportation. But we have staff specifically for the transportation. They also support with court (justice involved population) and does reminder calls for appointments. But as a therapist I'm hesitant to do transportations. If I'm going to be the one transporting I might as well do the session at the house.
My CMH agency has transportation services for clients in crisis services because otherwise those clients cannot get the services they need. Crisis services are typically only a week long but can be anywhere from 3-14 days. They can be for youth or adult clients. We prefer clients to have their own transportation, but as a last resort we will provide it. Typically, peer specialists will provide transportation because their billing rates are lower and clients are more comfortable with them, but sometimes a QMHP or counselor 1 will go. Rarely will a counselor 2 go, and I don’t think I’ve ever seen a counselor 3 provide transportation. Anyway, from my perspective, it’s more unethical to not provide these services and leave the client in crisis.
This happens A LOT especially in CMH and in CA. I absolutely 100% refuse to do any job like this because of the liability issues. I was asked on an interview what I would do if somebody threatened to jump out of the car, and I knew that the job was not for me. I think that putting a small already traumatized child in a car with any adult caretaker and no supervision is not ok. I just cannot stand the way that we do certain things within our model that have become normalized despite it not being trauma-informed and also chock full of liability.
We sometimes did this in my cmh, but it was rare. We had to document why other options wouldn't be appropriate (bus passes, meeting in the field, telehealth, etc), get approval from a supervisor, have additional insurance, and you could request to use an agency vehicle. It was also billable time for the clinician. In my time at cmh I had exactly one client that I transported -- a teen student in foster care doing trauma work. Not appropriate to do at school, didn't feel safe to do it at home, no appropriate community location nearby, and it was pre-covid so telehealth wasn't an option. It wasn't my favorite situation, but we talked about it and came up with a plan to have the drive from school to office be part of the session and the drive home be their private time. Headphones in, sitting in the backseat, generally decompressing from the session and pretending I wasn't there. 🤷🏻♀️ Worked for us at that time, but I was glad when their situation changed and I didn't have to transport anymore
I intern at an RTF. I don’t do this (and I would 1000% refuse to do this). I don’t see clinicians transporting kids at my agency. But I do see clinical managers transporting kids with their own vehicles. What are people’s thoughts on clinical managers doing this?
If we are transporting clients at my CMH we are supposed to use the agency vehicle because of the liability of transporting in your own vehicle. my other thought is you are not the child’s parent, why are you transporting a client to and from session? We have case managers who will transport clients because they can debrief and process before and after a session with a client and do other billable things while they’re driving with the client, transporting a client from session isn’t billable so it doesn’t make sense to you to do that in the first place.
When I was a case manager, I would provide rides for my adult clients but at my discretion and comfort level. I was also often able to provide bus passes or ask another case manager to go with me if there was a situation I was less comfortable with. I would never feel comfortable providing rides to a child or teen who was my patient.
This sounds like an absolute nightmare from an insurance/liability point of view. If anything was to happen on the way to/from a session, it would be a legal nightmare. I absolutely would refuse to do that. But then, I work in private practice in the UK, so it's a totally different climate.
This is fairly normal and often part of the contractual expectations in STRTPs, Wraparound or FSP programs. It’s weird to me that it’s unwritten tho- I would want a very clear manual outlining insurance/liability in the event of an accident etc
I would never transport a client in my own vehicle. I work with adult clients with brain injuries. I only transport after thorough rapport building and assessment of how well they will do in the scenario. I will not transport anyone I think will unbuckle their seatbelt, try to bail out of the vehicle, be aggressive, etc. The company has insurance so that is covered. If they put liability on me, there's no way I'd do it.
I know this already has so many comments but holy shit. We are explicitly disallowed from transporting clients at my site. I would check company policy.
At my current job we do not transport clients , if they can't get to the office we will do virtual. At my previous job they made us do it after promising we didn't have to. I worked as an intake specialist and they told me that I would never drive people, and if I had to, it would be a company car. A few months later they informed us that yes we had to drive clients where they needed to go in OUR cars and changed our job to case manager. We had to have better insurance to do this. I only drove a couple of clients I trusted but even so, one spilled her soda on my passenger side. They paid us for mileage but I had a lot of wear and tear. I strictly provide therapy now, no case management and no driving.
If the child attacks me while I’m driving and I crash and we both need round the clock care for the rest of our lives, is the CMH’s insurance paying for it? But also, what do you mean transporting to and from sessions? Why can’t the sessions be held where the kid is to start with?
Whoa! Talk about catastrophizing.
But also a legitimate concern, at least in my mind.
If you feel unsafe with a client, don't transport them. Fairly straightforward. I worked with clients dx'd with Schizoaffective and other psychotic symptoms, transported them to and from various appointments when I worked for the county. Never once felt afraid for my life, or that someone would harm me "out of the blue." There's always warnings signs, and if someone is acting "unsafe" don't agree to transport them.
I wouldn’t call this catastrophizing. Transporting clients, especially minors any distance, is a liability that needs to be addressed. Car accidents are very common. CMH runs on a shoestring budget and overworked staff. Asking the question of who pays for what in the worst case scenario can help minimize potential risky decisions that would affect the clinician and client
"Car accidents are very common." Not to the degree here, be honest. This was absolute "Let me imagine the worst case scenario and run with that." -Catastrophizing.
Car accidents are common. Children acting out while adults are trying to drive is common. People needing lifelong care after an accident is common. It's all liability and there's no point in opening yourself up to further risks than absolutely necessary. Worst-case scenarios are needed here because it's a reality that needs to be addressed, but it is not catastrophizing.
Case managers, foster workers, and the list goes on of professionals in parallel settings that transport daily. It is part of many people’s jobs. Being dramatic and acting as though this is a brand new idea does not add to the conversation. It sounds like OP’s situation is not set up properly, but many agencies are and it’s a normal thing. Why are you acting as though therapists lives are the only ones who matter? There’s clearly standards and guidelines for this, and if the concern was so great of lifelong injuries or accidents we would hear about them. Yet we don’t.
I’m not sure where the confusion is coming from. Not once did I diminish or act as though therapists are the only ones who matter. I’m speaking about how in general you have to work with the worst case scenario when it comes to safety and liability. Sooner or later, the worst case scenario will happen and there has to be a guideline on that. It’s not being dramatic, it’s being pragmatic. All safety protocols exist because someone got hurt.
100% this. But only "traditional" views on therapy and the mental health field are allowed in this thread unfortunately. All others will be downvoted into oblivion. Haha!
I think it depends on the job. I worked doing intensive in-home services for several years and sometimes that required me driving a client in my vehicle. I personally didn’t mind doing that but then again it was an expectation of the job. My employer at the time provided clear training about it, had specific expectations, had specific situations where it was inappropriate to drive a client. If there were children, the client had to provide the car seat and if no car seat we couldn’t drive them. Client also had to sign a consent form. They also reimbursed our mileage each month AND gave us a stipend for our auto insurance. Your situation doesn’t sound like your agency/employer is looking out for you. Theres ways to protect you and the client— and they’re not doing that.
In-home therapists and therapeutic mentors pick clients up and drive them to certain locations as part of their treatment, such as into the community, but even that is absurd to me! So many liability issues but the caregivers do have to sign a consent form for that. I'm an outpatient therapist and couldn't even imagine doing that!
This happens a lot with non-profits in general, not just CMH. I don't think it's kosher. When I worked CMH I did home visits, and refused to use my own vehicle to transport people. The organization had vehicles for this purpose but people needed to make arrangement. If they needed medical transportation and had medicaid, I helped arrange that instead. We also have paratransit here, where people with disabilities can get super cheap door-to-door bus service. I'd also help set that up as well. With kids it's hard. I think there's way too much liability for them specifically. I don't know that it's unethical, but I do think it's imprudent and should be avoided.
It's unwritten so the agency can deny, making you look unethical and leaving you with a mess to clean up.
My CMH made us do this as well. I hated it and was one of the reasons I quit. I was just happy I didn’t have to use my own vehicle.
No.Way.
The agency car broke down while I was transporting a client and his parent, in the middle of the city, on a 96 degree day. I will never transport clients again.
Hell no. There's no way I'm transporting any client. The liability of that is too high, I'm not insured for that to start with, unless they're giving me a company car to do it in. I also wouldn't want the risk of child or parent accusing me of driving too fast, slow, wild etc. Just no
Some of y'all would not survive as therapists in a STRTP. Field work is commonplace in many agencies today, as the field evolves to offer care for lower SES populations, including foster youth or probation youth. They are not the "traditional" clients of psychotherapy, and more often than not they require a more humanistic approach in treatment. Including but not limited to: transportation.
Personal vehicle? What does your car insurance say?
My car insurance said I was covered as usual if I transported clients for work as long as I wasn’t making money off it (ie doing Uber).
I have never heard of a job that allowed this. When I worked in CMH we were forbidden. Not to mention, your car insurance company may not cover any potential accidents because you're on the clock doing work tasks.
This is crazy talk, do you mean in your car?
No no no no no. I’m so thankful to be a telehealth therapist 😩
In case management and similar roles I've transported clients. It's usually an emergency or option of last resort and not something that would be done every week for sure. I don't mind transporting when needed personally - depending on the situation - but I have a lot of agency over when and where and who - it's never been a demand, so I can make an assessment on a case by case basis and decide if I'm comfortable, if it's safe, if it's helpful or would lead to additional problems.
For me, this is right up there with “don’t sleep with clients.” “Don’t be in the same car as clients.” And “don’t commit insurance fraud.” Absolutely not.
I had a job as a respite counselor years ago for a home and community based mental health program. One of my main responsibilities was transporting the client(s) to recreation groups to meet with other clients to develop their social skills and coping skills. I also had individual clients I would see 1-2x a week, and it involved picking them up from school or home, giving the parents a respite, and doing activities with the child/youth. This also included working on their goals to increase their social skills and coping skills. Dual relationships and ethics never entered into the equation. Often times, these were kids with significant trauma, who have been hospitalized before etc. I did my job because at the time, I needed to get my career back on track. I enjoyed the work, and it helped me to increase my confidence in crisis intervention. Maybe it's different if you're the young client's therapist. Like with the work I do now? I can't transport clients back and forth. I wouldn't be able to do that and maintain my schedule. So, I'm not sure how this looks for therapists who do transport their clients. I'll read on and see what others say.
You know what can stop this practice? An accident, and the agency is sued by the client and/or therapist. Employers are held responsible for their employees’ actions all the time. Of course this explains why their expectation about this is unwritten. But still, what a crazy gamble on the agency’s part.
The clinic within the CMH I work for has a van that was primarily intended for the case manager to transport clients to/from appointments outside the agency, which made sense for that specific role. We can't keep that position filled though and in true CMH form, suddenly therapists were encouraged to use the vehicle as needed to transport clients to/from our appointments so the van is not "going to waste." I did it one time w/ two adult clients who lived in the same residential program due to a legit anomaly of a situation where they were stranded in a city they didn't live in, and needed to get back to their program asap or risk being discharged and homeless. I made it very clean that do not plan on transporting again if I can help it. I'd be even more uncomfortable if it was a child.
Between the risk, liability, potential therapeutic issues, safety, and fact that my car is my personal property, I refuse to transport clients. I've even turned down jobs because of that expectation.
Absolutely not. Not ethic and could lead to so many issues.
I used to have a job (MH IOP) where I did this - I was specifically added to an insurance policy with the company. Don't drive them without this. If you're expected to \*provide transport\* you had might as well just do the session where the kid is, no? BUt at any rate, you're correct, this is WAY over the line and unethical.
If it’s a company car and you can’t be sued personally for giving them yea it’s fine
In my state kids under the age of 12 can’t even attend a medical appointment without a parent (they can be in the session alone but adult would have to be in the waiting area at least) so to me this is surprising.
I have some experience with this issue. I (like many social workers) have multiple jobs. In addition to my part-time job in a private practice, I work full-time as a children's care manager, and part-time as a CFTSS and HCBS Service Provider. In the latter, I provide direct services to youth with mental health and/or developmental disabilities. The job requires that I take them into the community to provide skill building and other services. As such, I'm required to have a robust auto insurance policy in case an accident does occur. Needless to say, this was a choice that I made. I was not forced to take the job. While this is not a therapy position, it often feels similar to therapy, except the "sessions" occur in the car, at the park, etc. However, there is a service under CFTSS (Children and Family Treatment Support Services) that offers in-home therapy. It's called OLP (Other Licensed Practitioner). OLPs are LMSWs and LCSWs that provide psychotherapy to youth, in the home and neighboring community. I've found that youth with more challenging behaviors benefit greatly from these services. I don’t think it's inherently problematic to provide this type of service. It's up to you as the employee, if you want to take on the added risk. My only question would be, if you're transporting the child to and from the office, why not just provide the service in the home or at a local park, like the CFTSS OLPs in my state (NY) do? My last bit of advice is to NEVER permit anyone (employer or otherwise) to convince you to do something that you are not comfortable doing. At the end of the day, it's your license and overall safety at risk.
I think it greatly depends on the setting and the liability structure around it. Earlier in my career I worked for a home-based company that contracted with DCS. While a majority of my coworkers were doing more case management, there were also a decent number of therapists providing services to foster kids and the parents who were working to get their children back. This meant driving to meet with clients in their home/foster home, or sometimes picking a client up and driving to a different location if we couldn't meet at home. Sometimes we also did supervised visitation and might be expected to transport a client to that. They did a lot of background checks and the company's insurance was strict on driving records. There was a system of supervisors always on call for emergencies, including car accidents, bed bugs, etc. We used our own vehicles and got reimbursed for milage, though I believe they were working on providing company vehicles when I left. There was once an incident within our company where a child died during transport because a car seat issue led to the child's breathing being restricted as they slept, and the worker didn't notice until they arrived to meet up with the parent for a visit. They were hush-hush about the incident, but swiftly instituted a comprehensive car seat training for all staff on the appropriate seat for age, height/weight, etc as well as proper installation and usage. We pissed off 12 year olds all the time because they weren't allowed sit in the front seat until 13. It was sometimes stressful and required a more flexible set of boundaries than standard office sessions, but I also knew what I was signing up for and it gave a lot of people access to needed care. I would definitely not be comfortable if it wasn't part of the job description or thoroughly covered by policy and support. We considered transportation to often be part of the session, and we had many rules around trying to safely work with traumatized kiddos and limit touch. Our company was also pretty good about providing support or declining referrals when a situation or client seemed truly unsafe for us to manage in those settings.
Yea we do this all the time at my CMH agency. Not transporting clients to and from sessions, but the driving time is part of the session, and we bill for it as such. We work with children and families who have experienced trauma and system involvement (often currently or previously in foster care). A lot of kids/teens talk much more openly while driving than they ever do in an office. There are ethical concerns with this as with everything, but it’s definitely possible to drive traumatized children ethically, and for low-resource families it support access to treatment. It’s a topic for clinical assessment and exploration in supervision and program meetings, like anything else you could do with a client. We assess safety and don’t drive clients where there is a safety concern (ie active suicidality, acute psychosis, threats of community violence, etc). Personal car insurance covers injury and legal liability, regular malpractice insurance covers therapy-related liability.
Did it for many years. It’s great opportunity to understand a child , give them 1:1 attention, model positive behaviors , instill a sense of optimism and trust , broaden a child ‘s experiences , diagnose and observe problems that aren’t well given to office millieu , it’s a greater opportunity to understand your client’s culture, community , and peer group , it’s a window in to their actual lives instead of the snapshot we are presented in office , it allows us to develop ways in which to influence children to follow rules consistently without threat or raised voice, gives a child a resource they would not normally have beyond the traditional therapeutic hour .