How to Ethically Set Client Confidentiality Boundaries

On this track, we will present the Confidentiality Risk Avoidance Procedure you might consider in order to avoid breaking ethical confidentiality boundaries.  This confidentiality procedure includes five steps:  Consult Colleagues; Obtain Proper Supervision; Review; Obtain Legal Consultation; and Document Decision-Making Steps.

Ethics - The 5-Step Confidentiality Risk Avoidance Procedure

Step 1. Consult Colleagues
The first step in the Confidentiality Risk Avoidance Procedure is consulting colleagues.  If you are uncertain about their handling of private, confidential, and privileged information concerning minors should consult colleagues who have specialized knowledge or expertise in this subject area.

Mental health professionals employed in settings that sponsor institutional ethics committees (committees that provide staff with a forum for consultation on difficult ethics cases) should take advantage of this form of consultation.  Moreover, mental health professionals named in ethics complaints and lawsuits can help demonstrate their competent decision making by showing that they sought consultation.

Step 2. Obtain Proper Supervision
The second step in the Confidentiality Risk Avoidance Procedure is obtaining proper supervision.   Mental health professionals who have access to a supervisor should take full advantage of this opportunity. Supervisors may help mental health professionals decide how best to handle private, confidential, and privileged information concerning minors.

Moreover, mental health professionals who are sued or named in an ethics complaint can help demonstrate their competent decision-making skills by showing that they sought supervision. In the case example, the social worker should immediately contact her clinical and administrative supervisors and apprise them of the confidentiality dilemma.

Step 3. Review
In addition to consulting colleagues and obtaining proper supervision, the third step in the Confidentiality Risk Avoidance Procedure is review.  This includes reviewing ethical standards, relevant regulations, laws, and policies, and relevant literature.  In regards to ethical standards, you might consider reviewing with the client the nature of confidentiality and the limitations of clients’ right to confidentiality. 

When considering the matter from a legal standpoint, you might want to consult federal, state, and local laws and their rulings on the sharing of health records.   Remember, State laws supercede federal, so to save time, I consult State laws first.  If State laws are not clear on the situation, I then consult federal laws, most especially the HIPAA guidelines which can normally clarify most situations. 

However, if neither of these levels give specific guidelines, as a last resort, consult the regulations set up by your own agency.  To give a quick overview, most states have strict laws and regulations governing the handling of minors' confidential health and mental health records.  State laws and regulations vary with respect to obligations to disclose confidential information when there is reason to believe that minors are engaging in selfharming behaviors threaten to harm others, or have a contagious or sexually transmitted disease.

All states require mental health professionals to report suspected abuse or neglect of children. Mental health professionals should consult local statutes, regulations, and child welfare officials to determine whether they are obligated to disclose confidential information to parents, guardians, and child welfare officials, even without the minor client's consent; permitted—but not obligated—to disclose confidential information to parents, guardians, or child welfare officials without the minor's consent; and not permitted to disclose confidential information to parents, guardians, or child welfare officials without the minor client's consent.

If you serve children, you might consider keeping current with relevant professional literature, especially pertaining to the proper handling of private, confidential, and privileged information. Reviewing such literature can provide you with useful guidance and also provide compelling evidence that you made a conscientious effort to comply with current standards.

Step 4. Obtain Legal Consultation
The fourth step in the Confidentiality Risk Avoidance Procedure is obtaining legal consultation if necessary.  If you are completely unsure about your ethical and legal duties concerning confidential and privileged information, you may want to consult with a lawyer for an interpretation of relevant statutes, regulations, and case law. By seeking legal advice, you may enhance your ability to argue that you made a "good faith" effort to practice ethically.

Step 5. Document Decision-Making Steps
In addition to consulting colleagues, obtaining proper supervision, reviewing, and obtaining legal consultation, the fifth and final step in the Confidentiality Risk Avoidance Procedure is documenting decision-making steps.  Thorough documentation of the steps taken to handle confidential and privileged information can help protect you should you be named in ethics complaints and lawsuits. Documentation demonstrates your conscientious
attempt to handle private, confidential, and privileged information responsibly.

On this track, we presented the Confidentiality Risk Avoidance Procedure you might consider in order to avoid breaking confidentiality boundaries.  This confidentiality procedure includes five steps:  Consult Colleagues; Obtain Proper Supervision; Review; Obtain Legal Consultation; and Document Decision-Making Steps.

Ethics CEU QUESTION 2
What are five steps to consider in order to avoid risking breaking confidentiality boundaries? To select and enter your answer go to Ethics CEU Answer Booklet.