I had a question about “who is the client” in terms of file names. When I worked at the IWK the client was always under the child name. That said, I would do a lot of parent work and so I was working with the parents only, in the service of the child who never actually attended the appointments.

Now that I’ve moved to private practice, I’m wondering if there is some standard to whose name needs to be on the file. When I or my admin first book a session with a family I rarely know if I will be working individually with a child/teen, with parents only, or a combination. Sometimes when I do parent work in the service of a child the parent puts their own name as the client. But sometimes parents put their child as the client even if I don’t work with the child, but work with the parent to support the child.

Is there any direction from an ethics perspective that I can use as I try to navigate being a flexible clinician who tends to take a whole family approach and often can include multiple people in the care?

NSBEP does not mandate whom the client is, rather we note the following information below for your consideration.

From the Code of Ethics for Psychologists:I.17 Recognize that obtaining informed consent is a process that involves taking time to establish an appropriate trusting relationship and to reach an agreement to work collaboratively and may need to be obtained more than once (e.g., if significant new information becomes available).

Additionally, we would note, that it would be important to consider the Mature Minor clause in determining whether the youth is able to understand and consent to services. Here is the relevant NSBEP publication on Age of Consent:

https://www.ns-rp.ca/downloads/Age_of_consent_position_statement.pdf

In addition to the above, the psychologist would consider the presenting reasons for seeking service along with whom is identified as a client on the intake form, as you note. It would be important to follow up if the named client is incongruent with the psychologist’s expectations. Clarification of same could be completed, in any event, prior to the start of the psychologist’s actual work with the individual(s) (clarifying with the parents who will be considered the client). This would also be helpful should any contentious matters arise later and one if the parties believes that they are the client, when this has not been the operationalization of the working relationship with the psychologist. Therefore, clarifying such matters at the beginning of service will help to make this clear to all parties.

We would note the below minimum standards with respect to Principle 7 of the NSBEP Standards of Professional Conduct, whereby:A registrant makes reasonable efforts to ensure that psychological records are complete and accessible and that their records and the records of those they supervise are secure and protected from loss, tampering or unauthorized use or access.

…n7.2 Individual client records will include the following (in particular, in bold):…nf. relevant information about every clinically significant service activity related to the client that is carried out by the registrant or under the responsibility of the registrant, including but not limited to: assessment procedures; assessment findings; diagnoses; goals or plans of service; reviews of progress including any modifications to plans of service; activities related to crises or critical incidents; interventions carried out or advice given.

…nj. a copy of every signed-consent and/or documentation of obtaining verbal consent related to the registrant’s service to the client.

You may find the other publications from NSBEP helpful also:Working with Children and Adolescents

https://www.ns-rp.ca/downloads/Age_of_consent_position_statement.pdf

Mandatory Reporting under the Children and Family Services Act

https://www.ns-rp.ca/downloads/NSBEP_Reporting_Child_Abuse_Memo.pdf

Nova Scotia Regulator of Psychology Statement Regarding the Release of File Materials.

https://www.ns-rp.ca/wp-content/uploads/2014/09/Raw-Data-General-Disclosure.pdf

While the document on file materials discusses legal obligations when a matter is under litigation, it is intended to address the release of file materials in general. Please note that under PHIA, if the file contained personal information of a child who was not seen by the psychologist (just parents were seen at the time), such information may later need to be provided should the child reach age of majority and request this information. It may be helpful to use the name of the child on the file for reference, though this is not a hard requirement from NSBEP and does not change the above considerations around consent.