The right to privacy
Community and disability services workers regularly work with sensitive information that is communicated in confidence. Confidentiality is a fundamental component of service provision. It safeguards client privacy and promotes trust between clients and service providers.
Confidentiality as a principle suggests that you keep information about clients private in order to safeguard their dignity and their right to the basic privacy afforded to every other individual.
Most organisations working in the human service industry have policies and procedures in place regarding privacy and confidentiality of information, based on legislative requirements.
Privacy legislation has been developed at both a state and a federal level. You can read more about this legislation in the topic Legislation with Confidentiality Provisions.
The following simple guidelines can help you maintain client confidentiality:
- Client information should never be discussed with friends or relatives in a social setting.
- Material kept in files about clients should generally relate only to the service delivery being offered to that client and factors that may affect service delivery.
- Confidential documents must be out of sight and reach in public areas. This includes vehicles. Keep any identifying documents in a locked bag or case.
- Client information should never be disclosed to neighbours or family, who may be contacting the service to find out whether the person is a client of the service.
- Client information should never be disclosed to other agencies that are not involved with the client. For example, the Department of Housing may want to report their concerns about a tenant who may or may not be a client of the service. In this situation, it is possible to receive information about the person, but not confirm whether the person is known to the service, without the client signing consent to release of information.
- Names and other personal details of clients should not be revealed in public forums such as meetings, conferences, workshops or seminars.
The child's right to privacy
The duty to maintain a child's confidentiality is heavily qualified by numerous public interest qualifications.
To summarise, they include:
- requests for information by police under the Police Powers and Responsibilities Act 2000 (Qld)
- release of information when someone or the general public is under serious and imminent threat
- releasing information to healthcare professionals as long as a recognised standard of treatment is being provided
- situations where the child is at risk.
Because of these complexities, it is important always to discuss the issue with your supervisor. It is quite a complex area with competing duties (to maintain confidentiality versus disclosure for safety reasons) and it is therefore necessary to involve senior staff in the decision.
A client discloses at interview that she wants to harm her sister's children, with whom she is currently living. Ordinarily, under the duty to maintain confidentiality, the information gained in the interview would be discussed amongst the team at the next review meeting and an appropriate plan of action would be developed. However, given the level of risk that the children are exposed to, it would be necessary to disclose the confidential information to the sister immediately so she can ensure the children are protected. The team would also need to consider whether there were any grounds to support a reasonable suspicion of mental illness, and therefore whether a request or recommendation could be enacted.
The issue of consent in relation to young people under 18 years of age is complex, and should always be discussed with senior staff. Decisions regarding consent of young people have been guided by the Gillick Principle.
The Gillick Principle was derived from a common-law principle which allowed for adolescents to be provided with services without the consent of their parents. It was found that the young person has a right to make their own decisions when they have sufficient understanding and intelligence to be capable of making up their own mind. It has been decided that a child has rights recognised by law, independent of his or her parents that are not determined by any specific age limit.
The Gillick ruling also states that children and young people should, if possible, be persuaded to allow their parents to be consulted; however, there is no obligation to do so. Therefore you should encourage young people to allow parents to be consulted. However, this would be inappropriate where a young person specifically refuses, or in the case of child abuse.
Reflect on how you might deal with this situation. Make notes in your personal journal.
Sharing information within your team
If clients ask you not to convey information to other team members, you need to remind them that service provision is team-based and issues of concern need to be brought to the attention of the team.
It is not good practice to withhold information from other team members, unless you have concerns about a conflict of interest. Team-based case reviews enable appropriate decisions to be made; this cannot happen if information is withheld from the team.
Should a client ask you not to inform the team about an issue, your response should be to inform them that the team needs to have access to all appropriate information in order to ensure the best outcomes for the client.
If a client with a mental illness tells you that they are no longer taking their medication and not to tell anyone else, this is information that should not be kept from the rest of the treating team. As the person is on an Involuntary Treatment Order, there is a higher duty to maintain the conditions of the order (compliance with psychiatric medications usually being a major condition of the order). Confidentiality can be breached, with the treating team having access to the information they require in order to ensure there is an appropriate response. This response could include increased monitoring to detect deterioration in mental state, joint interviews with doctors to determine reasons for non-compliance, medication change or change in the category to an ITO in-patient order.