Peer Providers: Confidentiality

Each client’s personal information is protected by law. Every talk you have with a client is confidential. Every written record about a client is confidential. Information can be shared with a clinic staff member who needs to know.

A word about HIPAA's privacy rules.

Be sure your clients know their rights to privacy under the HIPAA and state guidelines. For example, your teenaged clients have a right to give their own consent for treatment for STDs and for birth control services. Thus, unless your client gives you written permission, you cannot share your client's medical information with parents. To find out more about teens' confidentiality and privacy under HIPAA, go to www.youthlaw.org.

Explain the limits to confidentiality.

Explain that almost everything said is private and will stay between the client and clinic staff. Some things a client tells you may need to be reported to Child Protective Services (CPS) or to the police. This is especially true when someone’s health or well-being is at stake. (Read the next article on Mandated Reporting.)

Make sure you talk with your client in a private place.

Do not talk in clinic hallways, in the waiting room, or in a public place. These are not confidential places to talk with clients about family planning or sexual health. Other people might hear you.

Find out how to contact your client.

Ask all your clients if it is OK to contact them at home or to leave a message on the answering machine. If they are concerned about their parents or other people finding out, you need to work out a plan with them. Perhaps your teen client has a cell phone number or email address you can use. Maybe your client has a trusted who can relay a message.

Ask about your client’s health care plan.

Sending bills to your client’s home can compromise your client’s confidentiality. This is also true when the health coverage carrier sends itemized reports to the client’s home. For example, your teen-age client may use her parents’ health care plan. You may need to help your client find another way of paying for services. If your agency provides California Family PACT services, this would be a good option.

Make sure your client has a chance to ask questions privately.

Sometimes a client may come in with a partner, friend, or family member. For example, a teen may want her boyfriend to hear about how the birth control methods work. It may be OK to include him in the educational part of your session, with your client’s consent. Emphasize that it is her decision.

In addition, be sure to give the client time and space to ask any personal questions she may have. She needs to be able to make her own decisions, without undue influence of any other people. You may need to check with your supervisor about your agency’s practices about including partners, parents, or other friends and family members.

Share client information only when it is necessary for the health care of the client.

You should inform the clinician about client issues such as rape, substance use, and so on. You might also need to talk with a co-worker about a client’s health care issue. This is not breaking confidentiality. Talk to your supervisor about your clinic's protocol.

Think before you speak.

A client’s information may come up in a conversation in the lunchroom, lab area, or other place. Before you speak about a client, ask yourself, “Does this staff member need to know? Are there staff or other people who may overhear what I am saying?” If you really need to talk, but there’s no privacy, set up a time and place to talk later.

If you have a problem with a client, be appropriate.

Sometimes you may need a way to talk about your feelings, or think about ways to help a difficult client. Find your supervisor, and talk about your feelings in an appropriate place. Remember that there is a difference between dealing with your feelings and gossiping. You may want to wait to talk until the end-of-day check-out with your co-workers. If you need to talk sooner, be professional in your choice of place and limit the number of staff members who might hear. Don’t use client names or identifying information unless there is a valid need to do so.

Always keep the confidentiality of clients.

Let clients know you can be trusted. When you are out in the community, always let clients greet you before you say anything to them.

Think About It

Scenario 1: A girl you know from school comes into the clinic. She sees you and quickly looks away. You check the schedule and realize this client is your next appointment. What do you do?

• First, reassure the client about confidentiality.
• Ask the client if she would rather talk to another Peer Provider.
• If the client asks to see another Peer Provider, ask your supervisor to reassign the client.
• If there is no other provider available, reassure the client about confidentiality.
• Stay on the topic and talk about her reasons for the visit. Keep it professional.

Scenario 2: On the first day of school, you see a clinic client in your 2 nd period English class. You wait until the client greets you before you greet him. At first, he talks to you about the new teacher. Then he talks about his visit to the clinic. He wants to know if you can talk about his test results. What do you do?

• Let him know that it’s better to talk about clinic issues at the clinic.
• Let him know that he can call the clinic for an appointment or return for a walk-in visit.

Scenario 3: The mother of one of your teenaged clients comes storming into the waiting room and demands to know if her daughter is getting birth control. What do you do?

• First, calmly and respectfully, draw the parent to a quiet place to talk.
• Let her know that the services at your clinic are confidential and that you are not free to share that kind of information with anyone.
• If she has questions about what happens at a birth control visit, you can explain in a general way what goes on.

Scenario 4: Your client’s two girlfriends came with her to the appointment. She insists that she wants them with her every step of the way because she’s nervous. It’s her first time coming to the clinic. You feel her friends are having a lot of influence on your client and are giving her advice about what to do based on their own experience. The information they are sharing is not quite accurate. What do you do?

• First, let her friends know about much you appreciate the way they are supporting their friend.
• Point out that every client needs to have a time when she can ask questions freely. She also needs to be able to think things through on her own.
• Assure the client about what will happen next, to help make her less nervous.
• Ask the friends to go on back into the waiting room for a little while so that the client can ask the questions she needs answered.

This is a section from The Source: A Handbook for Peer Providers, Copyright 2006, by the California Family Health Council. To order copies, go to the store at www.healthed.org.