General Provisions and Cautions
One of the most important ethical responsibilities for peer support specialists is maintaining client confidentiality. This can be difficult in situations where the recovery community is relatively small and close-knit. Protecting the client’s privacy and guarding information contained in the clinical record is essential. Because of the stigma that is still associated with substance abuse and mental health issues, maintaining privacy and confidentiality is a critical aspect of protecting the client’s welfare.
Federal Confidentiality Law
Confidentiality for addiction treatment patients is considered so vital that a federal law (42CFR) outlines the provisions that must be followed. This regulation states that, in general, clinical records for substance abuse treatment clients are confidential and may be disclosed only as authorized by law and regulations. The law applies to clients in any treatment modality or treatment setting, regardless of how treatment is being funded and is higher in importance than state law in determining how confidentiality is protected.
Confidential client information cannot be disclosed without written consent from the client, except when a court order requests the release of the information. Even though peer support specialists are unlikely to be responsible for releasing the client’s record, it is important to know the requirements for protecting confidentiality and the requirements for obtaining a written release from clients if information is to be disclosed. For example, if a family member calls requesting information about a client who has not signed a consent form, the client’s treatment cannot be confirmed or denied.
Confidential client information can be released in only three ways:
- with client’s written consent
- without client’s consent, as specified in the regulations
- with a Court Order
For supplemental detailed guidance in this area, SAMHSA provides the following document online – The Confidentiality of Alcohol and Drug Abuse Patient Records Regulation and the HIPAA Privacy Rule: Implications for Alcohol and Substance Abuse Programs (2004).
Retrieve at: http://www.hipaa.samhsa.gov/Part2ComparisonCleared.htm
HIPAA and Electronic Health Records
Clinical records for addiction treatment clients are considered protected health information for the purposes of the Health Insurance Portability and Accountability Act (HIPAA). In addition to the provisions of 42CFR and state statutes governing confidentiality, addiction counselors and treatment agencies must also comply with these provisions. HIPAA was developed in conjunction with the use of electronic health records that could follow a patient from provider to provider. Many of the restrictions of the HIPAA rule are similar to those found in 42CFR.
Video: Electronic Health Records: Privacy and Security (1:55 minutes)
Duty to Warn/Protect
Protecting public safety is generally viewed as an ethical responsibility for helping professionals, including peer support specialists. Most people believe that helping professionals have an obligation to warn or protect people if they believe that their client is placing those people in danger. In this circumstance, the right to confidential treatment must be weighed against the need to ensure the safety of others. At the beginning of the peer relationship, the client should be informed of limits to confidentiality, including steps that must be taken to protect the general public, such as policies on notifying law enforcement personnel if a habitual DUI offender drives to a counseling appointment while intoxicated or an incident of child abuse is revealed. Peer support specialists should follow agency policy and consult with a supervisor if an issue regarding duty to warn arises.
Video: Part I: Confidentiality (5:49 minutes)
Respect and Dignity
Dignity is a feeling of worth or value that people have for themselves. Within the context of behavioral health, it means the kind of care that supports and promotes a person’s self-respect, regardless of their personal circumstances or characteristics. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as individuals. Because of the many ways in which behavioral health disorders can disrupt a person’s life, it is possible that the clients you see have lost touch with their own sense of self-worth. One of your most important jobs as a peer support specialist is to help your clients to regain their self-respect. By treating every client with respect, you model how they should treat themselves and others.
When you are dealing with your clients, you show them respect by:
- being polite
- being thoughtful and caring
- keeping them informed
- upholding their rights
- protecting their privacy
- supporting their autonomy
- using person-centered language
- treating them as an equal.
While treating a person with respect does not guarantee that they will feel a sense of dignity and self-worth, failure to behave respectfully is likely to damage a person’s dignity and make their road to recovery more difficult. An especially critical time for demonstrating respect for your client is during an episode of decompensation or relapse. At this time, the client may be experiencing feelings of shame and guilt that destroy their sense of pride and self-worth and they may take their cues from your response to the situation. If you continue to demonstrate respect for the client regardless of a relapse, they may more quickly regain their own internal feeling of being valuable and worthwhile. Watch this video to hear from actual patients what dignity and respect mean to them.
Video: What Do Compassion, Dignity and Respect Mean to You? (2:07 minutes)
Over the past decade, the recovery-oriented focus of the behavioral healthcare system has shifted to a “culture that is based on self-determination, relationships, and full participation of mental health consumers in the work and community life of society.” Self-determination shifts the service paradigm from clients as passive recipients of service to clients as critical decision-makers in their own care. It emphasizes peer-based, family-based and community-based approaches to services. Development of consumer-centered systems requires education on mental health and substance abuse treatment and services for consumers and their families and the development of policy, financing and planning efforts that support this new paradigm of service delivery.
Action Points – Client Rights
- The Peer Support Specialist should recognize and safeguard the rights of all clients.
- The Peer Specialist may not deny any of the basic client rights to an individual based on their status, characteristics or behaviors.
- The Peer Support Specialist must understand that all clients have the right to:
- Informed Consent
- Crisis Support
- Respect and Dignity
Module 7 Activity: Client Rights
Instructions: Click the box below to complete Module 7 Activity: Client Rights.