Learning Journal 8

Confidentiality

I was unable to attend this week so made some readings of my own on the topic and also referenced my own personal experiences given that confidentiality is a massive part of working with clients in my particular field of alcohol and substance misuse work.

Essentially confidentiality is the rule or promise that certain information will be held with restricted or limited access. What this means is that we make it known to a client that what they share with us is treated with respect and privacy, although we elaborate on the lack of absolutes. In the counselling field the BACP explains respecting privacy and confidentiality more thoroughly as “a fundamental requirement of keeping trust and respecting a clients’ autonomy” (BACP Ethical Framework). What this means to me is that we as practitioners need to be clear with our clients about what confidentiality actually is, how we will ensure that we maintain it but also what the limits to that confidentiality are.

I am always open and clear about confidentiality in both my group and 1-1 settings with clients. Certainly when I first meet with them I am very thorough about what it means to have what they tell me treated confidentially. I am also very clear that I store records on a database and that I work in a team, which means others may have access to these notes. I justify this as being necessary for us to provide a thorough and professional service, as my team may need access to what has been discussed in my absence or days off. I get them to sign a form with any names or organisations or agencies they would be ok with us sharing information with, such as a relative, GP or social services for example. Usually this is only level 2 data that we will share unless the client specifies we can share further. Level 2 data being simply acknowledging that the person attends the service and also how frequently they attend/miss sessions and also some surface acknowledgement of how they have engaged.

By ensuring the client is aware of these boundaries to confidentiality we can make it known to them how safe their disclosures are. The client can then trust the process in so much as they can feel what they disclose can only travel within certain limits and wont be shared unnecessarily with other people or agencies. Even if this were to happen the client would know that they are made aware of this sharing of information wherever possible. This is how we treat people with respect and dignity, which is all part of delivering both a professional service. Also this professional service being ethically sound and respecting the client’s autonomy as we ensure that they are fully informed of the process, its limitations and how their disclosures will be treated.

For me its very important that I am clear with clients about the limits to confidentiality but also that we work in a confidential way. They must be informed and give their consent. It gives them a feeling that they can open up and trust us as a service. Without any confidentiality how could they being to do any work or disclose anything at all? This all comes from being very clear about the boundaries to confidentiality in my opening contracting with clients when I do their full assessment after they have been allocated to me as a recovery worker. Additionally I get clients to sign a confidentiality waver so that we can with their consent contact the GP, store data and disclose certain information to others that they have specified. If I am open and clear about things like expectations of engagement or confidentiality and its boundaries at the outset, it means they client is given respect and autonomy and is informed to choose whether this is the service for them.

If ever I needed to break confidentiality I would seek the supervision of my line manager whenever possible. I would also involve the client whenever possible. It would really depend on the reasons for breaking confidentiality and what has been disclosed but essentiality my concerns would be around learning that any individual was at preventable risk of harm, or that a serious crime was or had taken place.

Last week a client’s brother called the service wanting to speak to me and encourage me to call the client. I could hear his desperation and that he had real concerns. I did my best to be polite and explain very clearly that I was unable to disclose client’s engagement in a respectful manner. I could also tell that this caller was likely to be legitimate and was very probably a concerned family member, however I did not have signed consent to speak to him about the client. What I did was suggest that he ask the client to call me and at least pass on verbal consent to speak to this person. While not ideal it would give me chance to confirm verbally in the mean time that should I receive a call from this individual I could at least acknowledge the client was known to us as a service.

This was a potential incident that was avoided by not disclosing. However on the other hand, had I gotten consent from the client before hand to speak to the family member, I would have been able to confirm the client was engaging with our service and that he was attending appointments, which may have left them feeling less anxious. Concerned relatives frequently call our service.

What this episode confirms to the client is that he can talk safely and openly with our service. We do not disclose information to third parties in these sorts of circumstances and that we treat his engagement in our service with respect. It left me feeling reassured despite the pull of a concerned brother being on the line at one point. No matter how much they want to know their brother is alive or trying to beat heroin, its not ok to share that information without the client’s consent. On this occasion I didn’t feel it presented an ethical dilemma as while I did have some feelings of wanting to help the distressed family member on the phone, this was overridden by my knowing the boundaries to confidentiality and why they are in place. At no point was I close to breaking the clients trust in us as a service.