Confidentiality Issues

Last week, I was about to conduct a psychosocial assessment with one of the clients, when he asked me about confidentiality issues. Previously, I had asked my task supervisor for more information on who would see the assessments once they are completed. She responded that if I am asked anything, just to say that I have to do the assessment. I was unsatisfied with this answer, so I asked my MSW supervisor what I should do without that information. He suggested I speak to the client about the HIPPA laws and go over ethical issues around confidentiality.

In the situation, the client was worried about who would be reading this assessment. Without a clear policy in the institution, it is difficult to ascertain who will be able to access the information. Prior to the closing of the transitions program, where most clients would go, the assessments stayed within the Samaritan Inns organization. Clients are currently placed in external programs for the transitional phase, and arrangements are sometimes made without client input. As a result, it is unclear who will be receiving this assessment. In addition, given the lax computer security, the records themselves are not very secure. (There are password protections for the computers and the records program, but both the username and password for staff members is their first name and last name. I log on under other people's usernames daily because I don't have one.)

The client vacillated between concern and compliance as he was asking these questions. The environment here does not lend itself to this type of concern. I validated his concern, spoke on confidentiality rules for me as a social worker, and discussed his rights under HIPPA. I told him that he had complete control of who saw his records. However, I was unable to tell him the answer to whether background checks or the government could access it. Provisionally, he decided to complete the assessment and not answer any questions he feels inappropriate. Luckily, the assessment did not contain any sensitive topic areas.