As a worker you will probably have a clear idea about confidentiality and many of you will have signed confidentiality agreements with your agencies. Many organisations deal with the issue of confidentiality in their policy and procedures manual. Privacy legislation also requires that you ensure that a client's family and health history are kept in a secure and confidential manner.
Writing exerciseQuestion - Can you suggest some of the ways that information about clients is exchanged?
- client files
- case notes
- letters and referrals
- by phone
When information is exchanged in correspondence between services (for example, when you make a request or make a referral), it is important to ask for the client's signed 'permission to exchange information' so that you do not breach confidentiality.
Writing exercise/group activityQuestion - Do you think that parents should have access to a young person's file notes? Are there any situations when this might be appropriate?
Question - If the young person is your client and not the family, how does this impact on your confidentiality agreement with the young person?
Question - Sometimes the young person's right to self-determination (the right to make their own choices and decisions) can conflict with their need to be parented. Can you come up with possible solutions to this dilemma?
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One way of dealing with these dilemmas is to discuss them with the young person concerned. You might be able to help them identify the advantages and disadvantages of telling their parents about the issues. This keeps the choice in the hands of the client.
Question - Are there any situations where the principle of confidentiality must be broken to protect the interests of the client?
Question - What confidentiality issues have been raised in your workplace (e.g. have you had a problem with paperwork going astray or has the receptionist discussed private information when other clients are listening)? How were these issues dealt with?
Question - How might these issues have been dealt with them more effectively?
Question - Are there any workplace procedures that prevent workers from maintaining the confidentiality of clients? For example, is confidentiality maintained during case meetings?
Question - How might these procedures be altered to give clients more protection?
Case studyRead the following case study and discuss your answers with another colleague. Write your answers down and then discuss with the large group.
A youth worker in an inner city youth centre had been working with a group of about 20 young people aged 14-20 who congregated on street corners near the centre. They had a passion for rave music, and over half of the group admitted to using drugs (mainly Ecstasy and LSD). The group complained of boredom, so a contract was drawn up with them to enable them to use the centre twice a week to play their music. They agreed that no illegal substances would be brought into the centre and that they would not attend the centre under the influence of drugs.
With the odd exception, this agreement was kept and the worker began helping a sub group on issues around drugs. Problems emerged when a drug dealer known to some of the people started hanging around outside the centre. Due to his close contacts with the young people, the worker had information which could lead to the arrest of the dealer. Colleagues and the majority of the members of the centre's management committee urged the worker to go to the police. The worker knew that this would mean losing contact with the young people and being labelled a 'grass'. He felt he had been making some headway with them on harm reduction strategies.
(Re-printed from Morgan & Banks, 2001)
Question - What do you think the worker should do in this situation?
- Is there a range of options?
- Whose interests are the most important to you as a worker?
- Is it possible to balance these competing interests?
Learners should be encouraged to discuss strategies for dealing with these types of situations.