client rights, hsw responsibilities & confidentiality hn450 – unit 4 client rights, hsw...

HN450 – Unit 4 Client Client Rights, HSW Rights, HSW Responsibilities & Responsibilities & ConfidentialityConfidentiality

The Unit 4 Project

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The Unit 4 Project

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The Unit 4 Project

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The Unit 4 Project

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Questions for discussion…

What do you think is meant by the term:

Informed Consent?

Take a few minutes to write your thoughts

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Client’s have a Client’s have a right to knowright to know

Informed consentInformed consent

Know what will happen, how it will Know what will happen, how it will happen, who will provide the service, how happen, who will provide the service, how long the services will take and HAVE A long the services will take and HAVE A RIGHT TO MAKE DECISIONS ABOUT RIGHT TO MAKE DECISIONS ABOUT IT ALLIT ALL

Shared decision makingShared decision making

Powerful toolPowerful tool

Client must understand in their own Client must understand in their own languagelanguage

It continues as long as the services are It continues as long as the services are being renderedbeing rendered


IncludesIncludes

Service provider backgroundService provider background

Education/training/certificationsEducation/training/certifications

How the information collected will be How the information collected will be usedused

Who has a right to know about the Who has a right to know about the informationinformation

Costs associated with servicesCosts associated with services


Con’tCon’t

Access to filesAccess to files

Benefits and risksBenefits and risks

Alternative services availableAlternative services available

If the sessions will be recorded in any wayIf the sessions will be recorded in any way

Record KeepingRecord Keeping

All interactions with client should be All interactions with client should be documenteddocumented

Provides a record of progressProvides a record of progress

Is ethically transparentIs ethically transparent

Legally keeps essential track of services Legally keeps essential track of services promised and providedpromised and provided

Risk management – keeps everyone clear about Risk management – keeps everyone clear about how things are goinghow things are going

Working with at-Working with at-risk populationsrisk populations

Federal Gov has certain populations that Federal Gov has certain populations that are considered at risk –are considered at risk –

WomenWomen

Adolescents/childrenAdolescents/children

CJ populationsCJ populations

Working with Working with children/adolescentchildren/adolescent

ssImportant issues to consider:Important issues to consider:

Minors’ rights regarding informed consentMinors’ rights regarding informed consent

Parental rights to information about a minor’s treatment Parental rights to information about a minor’s treatment

Minors’ Minors’ assentassent versus versus consent consent

Involving parents in the process with minorsInvolving parents in the process with minors

Limits to confidentialityLimits to confidentiality

Dealing with reluctanceDealing with reluctance

Confidentiality and Confidentiality and Related TermsRelated Terms

Confidentiality:Confidentiality:

rooted in a client’s right to privacy, confidentiality is rooted in a client’s right to privacy, confidentiality is at the core of effective human service work – but at the core of effective human service work – but there are limits – but a very narrow paththere are limits – but a very narrow path

Privileged communicationPrivileged communication::

a legal concept that generally bars the disclosure of a legal concept that generally bars the disclosure of confidential communications in a legal proceeding.confidential communications in a legal proceeding.

the specifics of this privilege vary from state to state. the specifics of this privilege vary from state to state.

PrivacyPrivacy: :

the constitutional right of individuals to be left alone the constitutional right of individuals to be left alone and to control their personal information and to control their personal information

Protecting Protecting Confidentiality RightsConfidentiality Rights

Fisher’s (2008) 6-step ethical practice model for protecting confidentiality rights:Fisher’s (2008) 6-step ethical practice model for protecting confidentiality rights:

1.1. PreparationPreparation

2.2. Tell clients the truth “up front” Tell clients the truth “up front”

3.3. Obtain truly informed consent before making a disclosureObtain truly informed consent before making a disclosure

4.4. Respond ethically to legal requests for disclosure Respond ethically to legal requests for disclosure

5.5. Avoid the “avoidable” breaches of confidentiality Avoid the “avoidable” breaches of confidentiality

6.6. Talk about confidentialityTalk about confidentiality

Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Issues and Ethics - Chapter 6 (2)

Limits of ConfidentialityLimits of Confidentiality

When clerical assistants handle confidential information When clerical assistants handle confidential information

When a worker is being supervisedWhen a worker is being supervised

When a client has given consentWhen a client has given consent

When a client poses danger to self or othersWhen a client poses danger to self or others

When a client discloses intention to commit a crimeWhen a client discloses intention to commit a crime

When a worker suspects abuse or neglect of a child or When a worker suspects abuse or neglect of a child or vulnerable adultvulnerable adult

When a court orders a worker to make records availableWhen a court orders a worker to make records available



Privacy Issues With Telecommunication Privacy Issues With Telecommunication DevicesDevices

Do not acknowledge that clients are receiving services or Do not acknowledge that clients are receiving services or give out information regarding clients to unknown give out information regarding clients to unknown callers.callers.

Strive to verify that you are actually talking to the Strive to verify that you are actually talking to the intended person when you make or receive calls in intended person when you make or receive calls in which confidential information will be discussed.which confidential information will be discussed.

Be aware that there is no way to prevent Be aware that there is no way to prevent your conversation from being recorded or monitored by your conversation from being recorded or monitored by an unintended person.an unintended person.

Be professional and cautious in talking about Be professional and cautious in talking about confidential information over the telephone; avoid confidential information over the telephone; avoid saying anything off the record.saying anything off the record.



Privacy Issues With Privacy Issues With Telecommunication DevicesTelecommunication Devices

Avoid making any comments that you would not want your client to hear or that you would not want Avoid making any comments that you would not want your client to hear or that you would not want to repeat in a legal proceeding.to repeat in a legal proceeding.

Do not allow unauthorized persons to hear answering machine messages in your office as they are Do not allow unauthorized persons to hear answering machine messages in your office as they are being left or retrieved.being left or retrieved.

If you use voice mail or an answering service, ensure that your access codes are not disclosed to If you use voice mail or an answering service, ensure that your access codes are not disclosed to unauthorized persons.unauthorized persons.

When you leave a message on an answering machine, be aware that the intended person may not be When you leave a message on an answering machine, be aware that the intended person may not be the one who retrieves your message. the one who retrieves your message.



Privacy Issues With Privacy Issues With Telecommunication DevicesTelecommunication Devices

If you are talking to a client by cellular phone, assume If you are talking to a client by cellular phone, assume that he or she is not in a private place. Realize that your that he or she is not in a private place. Realize that your conversation may be intercepted by an unauthorized conversation may be intercepted by an unauthorized person.person.

If you use a pager or a cell phone to send text messages, If you use a pager or a cell phone to send text messages, exercise caution. In sending a text message to a client, be exercise caution. In sending a text message to a client, be mindful of ensuring your client’s privacy by exercising mindful of ensuring your client’s privacy by exercising the same caution you would if you were sending a voice the same caution you would if you were sending a voice mail message.mail message.



Implications of HIPAA for Implications of HIPAA for Mental Health ProvidersMental Health Providers

The The Health Insurance Portability and Health Insurance Portability and Accountability Act of 1996 (HIPAA)Accountability Act of 1996 (HIPAA)

passed by Congress to promote standardization and passed by Congress to promote standardization and efficiency in the health care industry and to give patients efficiency in the health care industry and to give patients more rights and control over their health information. more rights and control over their health information.

The The HIPAA Privacy RuleHIPAA Privacy Rule developed out of the concern developed out of the concern that transmission of health care information through that transmission of health care information through electronic means could lead to widespread gaps in the electronic means could lead to widespread gaps in the protection of client confidentiality. protection of client confidentiality.



Implications of HIPAA for Implications of HIPAA for Mental Health ProvidersMental Health Providers

If you submit a claim electronically, even once, you If you submit a claim electronically, even once, you are likely to be considered a “are likely to be considered a “covered entity”covered entity” for for HIPAA purposes.HIPAA purposes.

Be familiar with the 4 standards of HIPAA:Be familiar with the 4 standards of HIPAA:

1.1. privacy requirementsprivacy requirements

2.2. electronic transactionselectronic transactions

3.3. security requirementssecurity requirements

4.4. national identifier requirementsnational identifier requirements



Duty to Protect Potential Duty to Protect Potential VictimsVictims

Balancing client confidentiality and protecting the public is a major ethical challengeBalancing client confidentiality and protecting the public is a major ethical challenge

Workers must exercise the ordinary skill and care of a reasonable professional to:Workers must exercise the ordinary skill and care of a reasonable professional to:

1.1. Identify clients who are likely to do physical harm to Identify clients who are likely to do physical harm to third partiesthird parties

2.2. Protect third parties from clients judged potentially Protect third parties from clients judged potentially to be dangerousto be dangerous

3.3. Treat those clients who are dangerousTreat those clients who are dangerous



Guidelines for Assessing Guidelines for Assessing Suicidal BehaviorSuicidal Behavior

Take direct verbal warnings seriously.Take direct verbal warnings seriously.

Pay attention to previous suicide attempts.Pay attention to previous suicide attempts.

Identify clients suffering from depression.Identify clients suffering from depression.

Be alert for feelings of hopelessness and helplessness.Be alert for feelings of hopelessness and helplessness.

Monitor severe anxiety and panic attacks.Monitor severe anxiety and panic attacks.

Ascertain whether there has been a recent diagnosis of a serious or terminal health condition.Ascertain whether there has been a recent diagnosis of a serious or terminal health condition.



Guidelines for Assessing Guidelines for Assessing Suicidal BehaviorSuicidal Behavior

Determine whether the individual has a plan.Determine whether the individual has a plan.

Identify clients who have a history of severe alcohol or drug abuse.Identify clients who have a history of severe alcohol or drug abuse.

Be alert to client behaviors (e.g. giving prized possessions away, finalizing business affairs, or Be alert to client behaviors (e.g. giving prized possessions away, finalizing business affairs, or

revising wills).revising wills).

Determine the history of psychiatric treatment.Determine the history of psychiatric treatment.



Protecting Children, the Protecting Children, the Elderly, and Dependent Adults Elderly, and Dependent Adults

From HarmFrom HarmMandatory reportingMandatory reporting

designed to encourage reporting of any suspected cases of child, elder, or dependent adult abuse; thus, designed to encourage reporting of any suspected cases of child, elder, or dependent adult abuse; thus, HSW’s are advised to err on the side of reporting in uncertain circumstances.HSW’s are advised to err on the side of reporting in uncertain circumstances.

If children, the elderly, or other dependent adults disclose that they are being abused or neglected, the If children, the elderly, or other dependent adults disclose that they are being abused or neglected, the professional is required to report the situation under penalty of fines and imprisonment.professional is required to report the situation under penalty of fines and imprisonment.

The professional has an obligation to protect those who cannot advocate for themselves. The professional has an obligation to protect those who cannot advocate for themselves.



Types of Elder AbuseTypes of Elder Abuse

Physical abuse Physical abuse

Sexual abuse Sexual abuse

Psychological or emotional abuse Psychological or emotional abuse

Neglect Neglect

Abandonment Abandonment

Financial or material exploitationFinancial or material exploitation



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