A colleague asked a very interesting and, I think, challenging question (based on a real world situation): he specializes in treating children with neurologically-based disorders.  He was talking to parents in the office and their child was in the waiting room, something triggered the child and the child damaged the waiting room.  The damage was considerable- several hundred dollars, possible up to $1000.  The question I was asked is, “who is responsible for the damage?”

Wow – what a question!  I don’t recall discussing this sort of problem in graduate school and fortunately have never had it happen in my own practice.  So, I posted the question on several listservs, including a national listserv for APA’s division 42 (Independent Practice) and MPA listservs.  Here is a summary of the responses, some of which do not respond to “who pays?” but do provide thoughtful insights:

  • Many responders started with, “Good question!”
  • Some wondered about whether the age of the child, the child’s diagnosis and the child’s decision-making capacity would matter. In other words, the clinician’s response might learn more towards “the parents are responsible” (and potentially could make the child pay them back, as a natural consequence) if the child the capacity to control his/her behavior.
  • Most respondents, however, advocated that the clinician should fund the repairs as “a cost of doing business.”
  • Some recommended at least discussing the situation with the clinician’s office liability insurance company (assuming that the clinician has this coverage – not everyone does). There is, however, the possibility, according to a few respondents, that the insurance company may view the damage as a crime and require that the clinician file a police report and the insurance company could possible try to recoup from the parents – obviously, raising some confidentiality concerns. Also, filing a claim may result in a higher premium.
  • Some of the wisest responses, I think, advocated that how the clinician responds can potentially be helpful for the therapy. For example, being supportive of the parents (I am guessing they were mortified) and working with them on how to manage such outbursts in the home could help with the therapeutic alliance. On the other hand, if the parents were not appropriately concerned, this clearly would be a major therapy issue.
  • Some respondents wondered about whether the child and parents should be referred to an office/clinic with more resources, such as staff that monitor the waiting room. This seems reasonable to consider.
  • One respondent recommended, if the clinician has the resources, having a separate “safe room” where children can wait while the parents are being seen. Another recommended scheduling appointments with only the parents if the plan is to see them without the child.
  • Several respondents who see more troubled children took this as sort of a cautionary tale and advised that the waiting room should be relatively sterile, with less things to potentially damage. This would mean that it is less attractive, but also less vulnerable to damage
  • Finally, one respondent suggested posting a sign in the waiting room that states that parents are responsible for monitoring their children and will be responsible for any damage. She reports that, in at least one office, this sign noticeably reduced minor damage, such as ripping up magazines.

So, thanks to all who responded. This may evolve into a regular MHConcierge feature – sort of “stump the experts” questions.

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