|
Home
|
|
Information Sharing & Confidentiality
Sharing and protecting the confidentiality of client information across agencies are critical issues in the effective treatment of all people with mental illness, but especially of children and adolescents.
The Hogg Foundation recently conducted research into the policy barriers that inhibit effective information sharing, a summary of which is presented here.
While the Foundation is no longer pursuing activities in this area, Foundation staff continue to serve as a resource to policymakers and advocates working on this critical issue.
A
child or adolescent with serious mental health needs may be assessed
and/or treated within a variety of agencies such as the school system,
the mental health system, or child protective services. The same
youth often interact with law enforcement and the juvenile justice
system (Cocozza, 1992).
Policymakers
and agencies providing services to youth with mental health problems
are becoming increasingly aware of the need to coordinate the provision
of services among child-serving agencies. System changes at all
levels of government are directed toward an integrated style of
service provision that reduces duplication of effort, lowers overall
cost of services, better utilizes scarce resources, and provides
holistic and comprehensive treatment for children and their families.
The growing trend towards community treatment of children with mental
health needs further demands that agencies function as cooperative
units.
Coordinated services and service integration can benefit youth,
families, and their communities in a number of ways. Integrated
approaches facilitate systemic, child- and family-focused problem
solving to comprehensively address the multiple needs of youth (Jones,
2002). Such an integrated approach focuses on the whole child and
family system rather than merely targeting the compartmentalized
aspects of the youth's behavior and rehabilitative needs (Hepburn
& McCarthy, 2003). Also, integrated services help youth and
their families by enhancing service accessibility and responsiveness,
reducing the confusion families experience in trying to navigate
through fragmented service delivery systems, and ensuring greater
continuity of care (Juszczak & Cohen, 1998; Konrad, 1996; Hepburn
& McCarthy, 2003; Slayton, 2000 ). In addition, integrated systems
of care may improve in prevention and intervention services because
they demand greater cooperation and accountability from providers
(Jones, 2002; Hepburn & McCarthy, 2003; Slayton, 2000).
Central to effective coordination and integration of services is
accurate and timely information sharing. The process of information
exchange, however, is often challenged by several factors. There
are legal barriers to information exchange among youth service providers.
A complex web of federal and state statutes and regulations restrict
access to confidential records. Nonetheless, the legal barriers
to interagency collaboration are fewer in number and far more circumscribed
than agency personnel generally perceive them to be (Etten &
Petrone, 2004; Slayton, 2000). To complicate matters, competitive
funding environments and disparate goals/mandates of agencies are
frequently implicated in problems associated with information sharing
(Etten & Petrone, 1994; Wolff, 1998). Indeed, the literature
suggests that the most significant barriers are misunderstanding
and confusion regarding state and federal regulations, certain aspects
of agency culture, and unnecessary policies.
Service providers who are faced with the prospect of sharing confidential
information with other providers often experience uncertainty about
how and when such information can be shared (Jonson-Reid, 2000;
Etten & Petrone, 2004). This uncertainty is due in large part
to the complexity of confidentiality laws. Such laws and regulations
are typically written in a manner that is hard for most service
providers to understand. In addition, confidentiality regulations
vary by type of record, include many exceptions to confidentiality,
vary from state to state, and are conglomerates of multiple state
and federal laws (U.S. Department of Health and Human Services,
1999); Jonson-Reid, 2000). According to the Surgeon General's Report
on Mental Health (1999), there is often significant disagreement
regarding the exceptions to confidentiality permitted by law. Most
confidentiality laws include exceptions for agencies and other entities
that have a "legitimate interest" in obtaining information
contained in confidential records. This "legitimate interest"
language is ambiguous and often applied differently across jurisdictions
(Redding, 2001; Henning, 2004). While such language is included
to provide judicial discretion in the interpretation of the law,
it can create greater confusion for service providers who are attempting
to obtain or disclose information contained in confidential records.
As a result, many service providers often err on the side of caution,
refusing to release information that could result in better care
for the youth they serve. Conversely, confusion regarding confidentiality
laws can also result in significant informal and often illegal information
sharing that can adversely affect the child and their family (Fried,
2000; Henning, 2004).
Competitive, unstable funding streams can create adversarial relationships
between agencies, which result in information territorialism, lack
of trust, and a misunderstanding of other agencies' missions, goals,
and operations (Etten & Petrone, 2004; Jonson-Reid, 2000). In
addition, there is a significant lack of funding for needed services,
much less for the gathering and sharing of information. Providers
often cannot find funding to compensate for the time involved in
the information sharing process or to overcome technological shortcomings
and incompatibilities that make information sharing cumbersome (Slayton,
2000).
Barriers to information sharing can result in ineffective, inaccurate,
and illegal information sharing between youth service providers,
posing significant consequences for youth and their families. This
is especially true for youth with mental health needs, who are more
likely to have multi-system involvement. Lack of sufficient information
sharing can lead to inappropriate treatment, inaccurate assessments,
and unmet needs (Blechman, Hile, & Fishman, 2001; OJJDP, 1997).
On the other hand, overzealous information sharing can result in
decisions that have long-term educational and socioeconomic consequences,
including expulsion from school, loss of public housing, and exacerbation
of delinquency (Henning, 2004). Sharing information accurately and
effectively is a balancing act to safeguard a child's confidentiality
while simultaneously communicating information necessary for appropriate
treatment and intervention.
Lynda E. Frost, Ph.D., J.D.
Kathleen A. Casey, M.A.
Flauren Fagadau, B.A.
Brandy Gazo, M.A.
References
Blechman, E, Hile, M., & Fishman, D. (2001). Restorative justice
and the prosocial solution. Youth & Society, 33, 273-295.
Cocozza, J.J. (Eds.)(1992). Responding to the mental health needs
of youth in the juvenile justice system. Seattle, WA: National coalition
for the Mentally Ill in the Criminal Justice System.
Etten, T. & Petrone, R. (1994). Sharing data and information
in juvenile justice: Legal, ethical, and practical considerations.
Juvenile and Family Court Journal, 65-83.
Fried, C. (2000). The exchange of information in Charlottesville/Albemarle:
Results from a survey of local agencies. Charlottesville, VA: Charlottesville/Albemarle
Juvenile Justice Advisory Committee, Charlottesville/Albemarle Commission
on Children and Families.
Henning, K. (2004). Eroding confidentiality in delinquency proceedings:
should schools and public housing authorities be notified? New York
University Law Review, 4, 1-75.
Hepburn, K. & McCarthy, J. (2003). Making interagency initiatives
work for children and families in the child welfare system. Promising
Approaches for Behavioral Health Services to Children and Adolescents
and their Families in Managed Care Systems, March, 7-66.
Jonson-Reid, M. (2000). Understanding confidentiality in school-based
interagency projects. Social Work In Education, 22, 13-33.
Juszczak, L. & Cohen, S. (1998). Integrating services to improve
access and outcomes for children and families. Quinnipiac Law Journal,
33, 1-22.
Konrad, E. (1996). A multidimensional framework for conceptualizing
human service integration initiatives. New Directions for Evaluation,
69, 5-19.
Office of Juvenile Justice and Delinquency Prevention (OJJDP). (1997).
National conference on juvenile justice records: appropriate criminal
and noncriminal uses (OJJDP Publication No. NCJ-164269). Sacramento,
CA: Search, The National Consortium for Justice and Statistics.
Redding, R. (2001). Judicial views on confidentiality and information
sharing in the juvenile justice system: A survey of Virginia juvenile
and domestic relations district court judges. Charlottesville, VA:
Institute of Law, Psychiatry & Public Policy.
Slayton, J. (2000). Establishing and maintaining interagency information
sharing. Juvenile Accountability Incentive Block Grants Program
Bulletin, March, 1-15.
Surgeon General’s Report: Mental Health. (1999). Confidentiality
of mental health information: ethical, legal, and policy issues.
Rockville, MD: U.S. Department of Health and Human Services.
Wolff, N. (1998). Interactions between mental health and law enforcement
systems: problems and prospects for cooperation. Journal of Health
Politics, Policy, and Law, 133, 1-28. References
Blechman, E, Hile, M., & Fishman, D. (2001). Restorative justice
and the prosocial solution. Youth & Society, 33, 273-295.
Cocozza, J.J. (Eds.)(1992). Responding to the mental health needs
of youth in the juvenile justice system. Seattle, WA: National coalition
for the Mentally Ill in the Criminal Justice System.
Etten, T. & Petrone, R. (1994). Sharing data and information
in juvenile justice: Legal, ethical, and practical considerations.
Juvenile and Family Court Journal, 65-83.
Fried, C. (2000). The exchange of information in Charlottesville/Albemarle:
Results from a survey of local agencies. Charlottesville, VA: Charlottesville/Albemarle
Juvenile Justice Advisory Committee, Charlottesville/Albemarle Commission
on Children and Families.
Henning, K. (2004). Eroding confidentiality in delinquency proceedings:
should schools and public housing authorities be notified? New York
University Law Review, 4, 1-75.
Hepburn, K. & McCarthy, J. (2003). Making interagency initiatives
work for children and families in the child welfare system. Promising
Approaches for Behavioral Health Services to Children and Adolescents
and their Families in Managed Care Systems, March, 7-66.
Jonson-Reid, M. (2000). Understanding confidentiality in school-based
interagency projects. Social Work In Education, 22, 13-33.
Juszczak, L. & Cohen, S. (1998). Integrating services to improve
access and outcomes for children and families. Quinnipiac Law Journal,
33, 1-22.
Konrad, E. (1996). A multidimensional framework for conceptualizing
human service integration initiatives. New Directions for Evaluation,
69, 5-19.
Office of Juvenile Justice and Delinquency Prevention (OJJDP). (1997).
National conference on juvenile justice records: appropriate criminal
and noncriminal uses (OJJDP Publication No. NCJ-164269). Sacramento,
CA: Search, The National Consortium for Justice and Statistics.
Redding, R. (2001). Judicial views on confidentiality and information
sharing in the juvenile justice system: A survey of Virginia juvenile
and domestic relations district court judges. Charlottesville, VA:
Institute of Law, Psychiatry & Public Policy.
Slayton, J. (2000). Establishing and maintaining interagency information
sharing. Juvenile Accountability Incentive Block Grants Program
Bulletin, March, 1-15.
Surgeon General’s Report: Mental Health. (1999). Confidentiality
of mental health information: ethical, legal, and policy issues.
Rockville, MD: U.S. Department of Health and Human Services.
Wolff, N. (1998). Interactions between mental health and law enforcement
systems: problems and prospects for cooperation. Journal of Health
Politics, Policy, and Law, 133, 1-28.
Selected
Resources
Establishing
and Maintaining Interagency Information Sharing (pdf)
State
Statutes on Juvenile Information Sharing
Health
Insurance Portability and Accountability Act (HIPAA)
Information
Sharing and the Family Educational Rights and Privacy Act
(pdf)
Family
Educational Rights and Privacy Act (FERPA) and Juvenile Justice
Guide
to Protecting the Privacy of Student Information
(pdf)
|
|
