About this tool: the Snowflake Approach

No two snowflakes are alike, yet every one grows from the same six-sided molecular structure. Referral decisions work the same way. Each client, clinician and situation is unique, but every decision rests on the same foundation.

Anna O'Brien, LPC, ATR-BC, introduced the Snowflake Approach in her 2025 continuing education presentation for the American Art Therapy Association (AATA), "Ethics of Clinical Referrals & Building a Sustainable Practice," along with a decision-making flowchart. Its six points are the therapist's beliefs, therapist self-care, law and professional codes, scope of training, treatment goals, and the therapeutic relationship.

This tool turns that flowchart into a step-by-step guide and applies it to the codes of ethics of the major mental health associations and credentialing boards. The six points appear as reflection prompts at each step.

Six points, one foundation

Before you begin

Please read and acknowledge these terms each session.

Educational decision support only. This tool organizes questions to consider. It does not give clinical, legal, ethical-board, billing or business advice. It does not tell you what you must do, and it is no substitute for supervision, consultation or your own professional judgment.
You remain responsible. Every decision is yours and must comply with your license, your state licensing board's rules, applicable federal, state and local law, payer contracts, and your employer's or practice's policies.
Ethics code summaries are paraphrases. Section summaries are short, unofficial paraphrases written for this tool. They are not the official text and may be incomplete or out of date. Codes are revised (ACA's revision is expected in fall 2026, and APA's is in progress). Always read the current official code. Content last reviewed November 2026.
Legal references are informational, not legal advice. The tool names anti-discrimination laws and agencies so you know where to look. It does not interpret them or say whether they apply to you. Talk to a qualified attorney about your situation.
Do not enter client information. The tool has no free-text fields and does not collect, store or send anything you select. Your answers stay in this browser tab and are cleared when you close it.
Not for emergencies. If a client is at imminent risk, follow your crisis protocol and contact 988 (Suicide & Crisis Lifeline) or 911.
Availability not guaranteed. The tool is offered as a convenience. It may be unavailable, interrupted, changed or discontinued at any time without notice, including during website maintenance or outages. Don't depend on it for time-sensitive decisions; the official codes, your supervisor or consultant, and your licensing board remain your primary resources.
No endorsement or affiliation. The tool is not affiliated with or endorsed by AATA, ACA, NBCC, APA, NASW, AAMFT or any other organization or credentialing board named here.
Provided "as is". The author makes no warranty about accuracy or completeness. To the fullest extent permitted by law, the author accepts no liability for decisions made or actions taken using this tool. Use of the tool creates no professional, supervisory or consulting relationship.

I have read and understand these terms, and I will use this tool only as educational decision support.

Which codes apply to you?

Select every code you are bound by: professional association memberships, board certifications and credentials. Many clinicians hold more than one. Where codes differ, follow the strictest standard and the law.

Codes with section-by-section guidance

Other credentials and certifications

Each of these has its own code. The tool links to the code and reminds you to check its matching standards at each step.

Which state do you practice in?

This is used only to point you to that state's anti-discrimination law and agency. It stays in this browser tab and is never sent anywhere.

Your state licensing board's rules always apply.Many boards adopt or reference a professional code, and some add their own rules. Check your board's regulations too.

Outcome

Reassessment date (optional)

The summary has no client identifiers. If you add it to a client record, follow your record-keeping and privacy obligations.