Confidentiality in Direct Social-Work Practice: Inevitable Challenges and Ethical Dilemmas

Abstract

Social workers have long concerned themselves with confidentiality and its importance to practice. In 1922, social workers created theirCode of Ethics, a major precept of which is the protection of confidentiality, defined as the regulation, both legal and ethical, that protects the client's rights of privacy. Social workers are confronting many ethical issues related to confidentiality, such as increasing demands for accountability, mandated duty-to-protect or -warn provisions, expanding court involvement in professional decision making, and widening access to information in records through the expanded use of computer technology. The objective of this study was to learn more about practitioners' ethical dilemmas in maintaining client confidentiality. A mailed, anonymous survey of experienced social-work practitioners was conducted to gain an understanding of how practitioners address confidentiality issues in their work with clients and to identify specific areas in which practitioners experience ethical dilemmas related to confidentiality, the factors contributing to these dilemmas, and the resources used by practitioners to resolve them. Major issues of practitioner concern and specific areas in which practitioners felt a need for more resources, education, and policy clarification were identified.CONFIDENTIALITY CAN BE DESCRIBED as the regulation, both legal and ethical, that protects the client's rights of privacy. It refers "broadly to legal rules and ethical standards that protect an individual from unauthorized disclosure of information" (Smith-Bell & Winslade, 1994, p. 184). Confidentiality creates boundaries around the client/worker relationship. It also creates boundaries around information outside of that relationship, including information that can be communicated within, between, and among agencies (Rhodes, 1992).As social workers, we define and balance our obligation to safeguard confidential client information with the rights of the individual, organization, and community to access that information (

Student Risk-Taking Behaviors: When Do School Counselors Break Confidentiality?

“…The results of this study show that there was some consensus among school counselors with regard to breaking confidentiality to report suicidal ideation, but there was much less consensus with the other risk-taking behaviors. However, ethical decisions must be made on a daily basis and the most ambiguous or most difficult areas may be the ones that we are forced to navigate the majority of the time (Millstein, 2000). For example, self-mutilation is becoming a more common behavior observed in schools (White Kress et al, 2006), yet the counselors in our sample didn't agree on how to respond to this behavior.…”

Confidentiality in Clinical Writing: Ethical Dilemmas in Publishing Case Material from Clinical Social Work Practice

“…In general, confidentiality has been defined as the legal and ethical regulations that protect either the research participants or the clients in terms of their rights to privacy (Millstein, 2000). Ethical dilemmas center on conflicts between the rights of the individual to privacy versus the rights of the larger community to have access to the client's private information.…”

“…In direct practice, such conflicts are evident in the dilemmas about writing and protecting case records, in sharing confidential information for purposes of referral or consultation, in following mandates regarding duty-to-warn or duty-toprotect, and when there is court involvement such as in child welfare cases and adoption (Millstein, 2000;Palmer & Kaufman, 2003;Reamer & Siegel, 2007;Saxon, Jacinto, & Dziegielewski, 2006). Yet Millstein's (2000) study of 372 direct practice MSWs suggested "there is a gap" (p. 278) between what clinicians understand to be their ethical obligations and what they actually do in practice, particularly regarding confidentiality. More than one half the respondents in Millstein's study reported they did not have clients sign consent forms prior to the release of confidential clinical information to other professionals.…”

Comparing the Ethical Code Implementation among Social Workers in Africa: Can Years of Experience Make a Difference?

“…They imprecise about explanation and implication inherent in the principles to be translated into practice; practitioners often do not employ the ethical code during practice and practice is mostly directed by administrative processes and law making the code superfluous (Reamer and Shardlow, 2009;Millstein, 2000;Clark, 1999). Researchers have explicated that practitioners are apt to create choices relying on technical aspects contained by job description than centring it on Code of Ethics' principles and values; only an insignificant figure of practitioners (15.9%) consulted to the code to solve ethical dilemma; ensuing legal regulation adherence make practitioners to perform incongruity to the code (Kugelman, 1992;Millstein, 2000;Reamer, 2005).…”