Confidentiality in Social Work
Clinical social worker Jim Hardeman almost landed in jail once for refusing to turn over confidential client records.
Hardeman, who was managing a corporation's employee assistance program at the time, had counseled both parents involved in a heated custody battle. Because of his work with the pair, the court ordered Hardeman to turn over his therapeutic records regarding the couple. "I got sucked in," he says. "They wanted to use my records to help decide who made a better parent."
Hardeman refused and was able to avoid jail time when his company's lawyers worked out a compromise that made only certain parts of his records available.
Sticky situations like Hardeman's are not unusual in the world of clinical social work, nor are the pains Hardeman took to protect confidential client information. Various federal and state laws recognize the confidentiality of therapeutic relationships, while at the same time requiring social workers to report abuse of children, senior citizens or people with disabilities.
In cases where a client is suicidal, homicidal or threatening a social worker, the social worker may also find it necessary to disclose confidential client information, says Mirean Coleman, a clinical social worker and a senior policy associate for the National Association of Social Workers.
A social work student was murdered in 2002, partly due to a misunderstanding about when it is appropriate to breach confidentiality, says Hardeman, who is now executive director of Workplace Violence Interventions and Strategies in Plymouth, Massachusetts. Despite receiving direct threats from her client in the past, the student attempted to transport the client to another agency. Her client shot her in the car. The tragic event illustrated that more work needs to be done to teach students and other newcomers to the field that safety comes first. "Don't put yourself in danger," Hardeman says.
Similarly, in Hardeman's corporate days, he arranged for a mentally ill worker to be arrested and committed to a psychiatric ward. The worker had experienced a psychotic breakdown and had scrawled anti-Semitic graffiti and swastikas all over the room where his bosses had put him to isolate him from coworkers.
"There is no confidentiality when violence is in the building," Hardeman reiterates. "I had to maintain the safety of his coworkers." If a client is threatening violence, Hardeman recommends that social workers touch base with a supervisor and other professionals in the organization who have expertise working with similar cases. "Never be a lone ranger," he says.
State and Federal Guidelines
In cases where violence is not a factor, decisions about whether to maintain a client's confidentiality may be less obvious. For example, a social worker may be legally required -- but morally opposed -- to providing information about an undocumented immigrant, Hardeman says. Or, according to Coleman, a social worker may be asked by an adolescent client's parents to share the adolescent's therapeutic records. In such cases, state laws differ on how to respond to the requests; therefore, social workers should stay informed on what's happening in their area.
Social workers should also be aware of federal confidentiality guidelines as well as guidelines in the NASW code of ethics, Coleman says. The NASW and its state affiliates provide continuing-education programs, seminars and workshops on ethical dilemmas related to confidentiality. The organization also makes a law book on confidentiality, which includes information on dealing with subpoenas, available to members.
When social workers do have to reveal confidential client information, it is important that they do so openly and in a way that maintains the client's dignity. No client should be completely surprised, since a social worker is required to make clients aware of the limits and exceptions to confidentiality at the first meeting.
Hardeman, for example, has called clients or told them in session that he planned to report their negligence to child protective services. "I tell them I'll work with them and won't abandon them," he says. Some clients appreciate his candor and continue working with him anyway. "If I operated behind my clients' backs, they'd quit therapy and never go to therapy again," he says.