Ethics of Working With High-Risk Clients
Live Event

Ethics of Working With High-Risk Clients

Wed, Feb 24th, 2027
11:00am – 2:15pm US Eastern Time
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About the Event

Working with high-risk clients requires clinicians to balance client autonomy, confidentiality, therapeutic alliance, safety, ethical responsibilities, and appropriate risk management. This training examines ethical and clinical considerations that arise when working with clients presenting with suicide or self-harm risk, violence or homicide concerns, abuse or neglect, severe substance use, psychosis or impaired judgment, interpersonal violence, exploitation, and other circumstances involving elevated vulnerability or potential harm. Participants will explore challenging situations involving informed consent, limits of confidentiality, clinician competence, documentation, consultation and supervision, safety planning, continuity of care, boundaries, and decisions regarding referral or a higher level of care. Attention will also be given to common challenges such as uncertainty in risk assessment, client refusal of recommendations, conflicting ethical responsibilities, clinician anxiety, therapeutic ruptures, and balancing protective intervention with client autonomy. Case-based learning will allow participants to examine complex situations in which there may be competing clinical, ethical, and risk-management considerations rather than a single obvious response. Practical strategies will help clinicians strengthen ethical decision-making, consultation practices, documentation, and risk-management approaches when providing care to high-risk clients.

Live Event
This live online event will be held as a Zoom Webinar. Attendees will have the option to interact through features such as the Chat and Q&A, but cameras and microphones will not be enabled.

Live Event Instructor

Diane Bigler

Diane Bigler

Diane Bigler, LCSW, LSCSW has over 25 years of experience in social work and mental health practice. She is a frequent national continuing education speaker and former Professor of Social Work at The University of Kansas, School of Social Welfare. Diane has been involved in the provision of clinical supervision for over 15 years and has trained hundreds of clinicians on succeeding at supervision.

Target Audience

This live interactive is intended for Behavioral Health and Addictions professionals, including psychologists, social workers, counselors, marriage & family therapists, art therapists, school psychologists, psychoanalysts, music therapists, behavior analysts, school counselors, and addiction counselors. It is appropriate for all levels of knowledge.

Learning Objectives

After taking this activity, you should be able to:

  1. 1 Identify ethical, clinical, and risk-management considerations associated with working with clients who present with elevated risk of harm, vulnerability, or impaired decision-making.
  2. 2 Apply ethical decision-making principles to complex situations involving confidentiality, informed consent, competence, consultation, documentation, client autonomy, and safety.
  3. 3 Evaluate high-risk clinical scenarios to determine appropriate risk-management strategies, consultation needs, protective interventions, and continuity-of-care considerations.

Bloch-Elkouby, S., & Barzilay, S. (2022). Alliance-focused safety planning and suicide risk management. Psychotherapy, 59(2), 157. https://doi.org/10.1037/pst0000416

Brenner, L. A., Capaldi, V., Constans, J., Dobscha, S., Fuller, M., Matarazzo, B., ... & Bahraini, N. (2025). Assessment and management of patients at risk for suicide: synopsis of the 2024 US Department of Veterans Affairs and US Department of Defense clinical practice guidelines. Annals of internal medicine, 178(3), 416-425. https://doi.org/10.7326/ANNALS-24-01938

Ghahari, D., Chaharlangi, D., Bonato, S., Sliekers, S., Sockalingam, S., Ali, A., & Benassi, P. (2024). Educational approaches using simulation for psychiatric risk assessment: A scoping review. Academic psychiatry, 48(1), 61-70. https://doi.org/10.1007/s40596-023-01836-z

Hawton, K., Lascelles, K., Pitman, A., Gilbert, S., & Silverman, M. (2022). Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. The Lancet Psychiatry, 9(11), 922-928. https://doi.org/10.1016/S2215-0366(22)00232-2

Jobes, D. A., & Barnett, J. E. (2025). Evidence-based care for suicidality as an ethical and professional imperative: How to decrease suicidal suffering and save lives. American Psychologist, 80(3), 311. https://doi.org/10.1037/amp0001325

Disclosure to Learners

CE Learning Systems adheres to the ACCME's Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CE activity – including faculty, planners, reviewers, or others ― are required to disclose all relevant financial relationships with ineligible entities (formerly known as commercial interests).

The following relevant financial relationships have been disclosed by this activity's planners, faculty, and the reviewer:

Planners and Reviewers

The planners of this activity have reported that they have no relevant financial relationships.

Faculty

There are no known relevant financial relationships to disclose.

Commercial support

There is no commercial support for this distance-learning course.

Use our CE Approvals tool to look up your state requirements and how can help you meet them, or log in to your member account to show approvals relevant to your licensure.

Joint Accreditation (JA)

3 Psychologist CE credit hours
3 Social Worker CE credit hours Ethics
Eligible until Feb 24th, 2027
In support of improving patient care, CE Learning Systems, LLC, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
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Logo: Jointly Accredited Provider (tm) - Interprofessional Continuing Education

American Psychological Association (APA)

3 CE credit hours Ethics
Eligible until Feb 24th, 2027
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs.
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Logo: American Psychological Association

Association of Social Work Boards (ASWB ACE)

3 CE credit hours Ethics
Eligible until Feb 24th, 2027
As a Jointly Accredited Organization, CE Learning Systems LLC is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 3 ethics continuing education credit(s).
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Logo: ASWB ACE approved continuing education

National Board for Certified Counselors (NBCC)

3 CE credit hours
Eligible until Feb 24th, 2027
CE Learning Systems has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5951. Programs that do not qualify for NBCC credit are clearly identified. CE Learning Systems is solely responsible for all aspects of the programs. 3 NBCC hour(s) awarded.
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Logo: Approved Education Provider - NBCC

NAADAC, the Association for Addiction Professionals (NAADAC)

3 CE credit hours
Eligible until Feb 24th, 2027
This course has been approved by CE Learning Systems, service provider of Impact CE, as a NAADAC Approved Education Provider, for educational credits. NAADAC Provider #192243, CE Learning Systems is responsible for all aspects of their programming.
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NAADAC Approved Education Provider

Florida Certification Board (FCB)

3 CE credit hours
Eligible until Feb 24th, 2027
Impact CE, a service of CE learning Systems, is approved by the Florida Certification Board (FCB) to offer continuing education programs (Provider # 5069A).
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Michigan Board of Physical Therapy

3 CE credit hours
Eligible until Feb 24th, 2027
Impact CE, a service of CE Learning Systems, is approved by the Michigan Board of Physical Therapy (Provider # 50-315).
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Missouri Credentialing Board (MCB)

3 CE credit hours — Ethics
Eligible until Dec 30th, 2026
AddictionCounselorCE is an approved provider of the Missouri Substance Abuse Professional Credentialing Board (Provider #101). AddictionCounselorCE maintains responsibility for this course and its contents.
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New York Education Department Board of Social Work

3 contact hours
Eligible until Feb 24th, 2027
CE Learning Systems, LLC, (d/b/a impactce.com) is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers. Provider #0060.
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New York Education Department Board of Creative Arts Therapy (NYSEDCAT)

3 CE credit hours
Eligible until Feb 24th, 2027
CE Learning Systems (d/b/a impactce.com) is recognized by the New York State Education Department's State Board for Mental Health Practioners as an approved provider of continuing education for licensed creative arts therapists. #CAT-0008
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New York Education Department Board of Mental Health Counseling

3 CE credit hours
Eligible until Feb 24th, 2027
CE Learning Systems, LLC (d/b/a impactce.com) is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors. #MHC-0072.
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New York Education Department Board of Psychologists

3 CE credit hours
Eligible until Dec 29th, 2026
CE Learning Systems, LLC, (d/b/a impactce.com) is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for psychologists, # PSY-0016.
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New York Education Department Board of Marriage and Family Therapy

3 CE credit hours
Eligible until Feb 24th, 2027
CE Learning Systems, LLC (d/b/a impactce.com) is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed marriage and family therapists #MFT-0045.
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New York State Education Department's State Board for Physical Therapy

3 CE credit hours
Eligible until Feb 24th, 2027
CE Learning Systems (d/b/a impactce.com) is recognized by the New York State Education Department's State Board for Physical Therapy as an approved provider of continuing education for Physical Therapists and Physical Therapist Assistants.
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Texas Board of Physical Therapy Examiners

3 CE credit hours
Eligible until Feb 24th, 2027
This activity has been approved by the Texas Board of Physical Therapy Examiners for 3 CCUs for PTs and PTAs. APS # 2805075TX. Accreditation Period: 6/1/25-5/31/28
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Virginia Certification Board (VCB)

3 CE credit hours — Ethics
Eligible until Dec 30th, 2052
Virginia Certification Board educational provider # 106
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Event Agenda

Agenda times are listed in US Eastern Time. That is 3 hours later than US Pacific Time. The event starts at 8:00am US Pacific Time.

11:00 AM–12:30 PM: Part 1 – Defining “High-Risk” Clinical Practice
  • What Makes a Client or Situation High Risk?
  • Risk to Self, Others, or From Others
  • Vulnerability, Impaired Judgment, Exploitation, and Instability
  • Clinical Risk vs. Ethical/Legal Risk
  • Avoiding Assumptions Based Solely on Diagnosis
  • Examples of High-Risk Clinical Situations
  • Suicide and Non-Suicidal Self-Injury
  • Violence or Threats Toward Others
  • Psychosis, Mania, or Significantly Impaired Judgment
  • Severe Substance Use and Overdose Vulnerability
  • Intimate Partner Violence and Coercive Control
  • Abuse, Neglect, Exploitation, and Trafficking
  • Clients Experiencing Significant Instability or Rapid Deterioration
  • High-Risk Transitions, Disengagement, and Treatment Refusal
  • Core Ethical Challenges
  • Autonomy vs. Safety
  • Confidentiality and Its Limits
  • Beneficence and Nonmaleficence
  • Client Capacity and Informed Decision-Making
  • Multiple Competing Ethical Responsibilities
  • Cultural and Contextual Considerations
  • Informed Consent With High-Risk Clients
  • Discussing Limits of Confidentiality Before a Crisis
  • Emergency Procedures and Communication Expectations
  • Involving Supports and Collateral Contacts
  • Telehealth and Emergency Planning
  • Revisiting Informed Consent as Circumstances Change
  • Case Study #1: When Autonomy and Safety Collide
  • Complex Case Involving Multiple Risk Factors and Client Refusal of Recommendations
  • Whole-Group Ethical Decision-Making Discussion
  • Learning Application: “What Would You Do Next?”
  • Brief High-Risk Scenarios Requiring Learners to Identify the Immediate Ethical and Clinical Priority

12:30–12:45 PM: BREAK


12:45–2:15 PM: Part 2 – Competence, Consultation, and Risk Management

  • Competence and Scope of Practice
  • Recognizing Limits of Competence
  • When Specialized Assessment or Treatment Is Needed
  • Referral vs. Continued Treatment
  • Avoiding Abandonment
  • Maintaining Competence for Foreseeable High-Risk Situations
  • Consultation, Supervision, and Collaboration
  • When to Seek Consultation
  • Using Consultation to Strengthen—Not Replace—Clinical Judgment
  • Interdisciplinary Collaboration
  • Appropriate Use of Collateral Information
  • Documenting Consultation and Clinical Reasoning
  • Risk Management in Everyday Practice
  • Assessment Proportional to the Presenting Concern
  • Safety and Crisis Planning
  • Follow-Up and Continuity of Care
  • Missed Appointments and Abrupt Disengagement
  • Higher Levels of Care and Emergency Intervention
  • Managing Clinician Anxiety and Avoiding Defensive Practice
  • Documentation With High-Risk Clients
  • What Was Assessed
  • Relevant Risk and Protective Factors
  • Client Statements and Behavior
  • Clinical Reasoning and Decision-Making
  • Interventions, Consultation, Referrals, and Follow-Up
  • Documenting Why a Particular Course of Action Was Chosen
  • Case Study #2: The Client Who Stops Coming
  • High-Risk Client Abruptly Disengages From Treatment
  • Outreach, Confidentiality, Boundaries, Continuity of Care, Documentation, and Consultation
  • Case Study #3: When Risk Is Coming From Someone Else
  • Client Experiencing Interpersonal Violence, Coercion, Exploitation, or Abuse Declines Recommended Assistance
  • Balancing Autonomy, Safety, Confidentiality, and Clinician Responsibilities
  • Common Challenges and Ethical Pitfalls
  • Overreacting Because of Clinician Anxiety
  • Underreacting Because of Fear of Damaging Rapport
  • Practicing Outside Competence
  • Excessive or Insufficient Disclosure
  • Inadequate Consultation
  • Poor Documentation
  • Treating Risk Assessment as a Checklist Rather Than an Ongoing Process
  • Closing Ethical Decision-Making Challenge
  • What Do I Know?
  • What Information Is Missing?
  • What Ethical Principles Are Competing?
  • What Is Within My Competence?
  • Do I Need Consultation?
  • What Action Is Clinically and Ethically Supportable?
  • What Needs to Be Documented?

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