Play 4

Confidentiality

OVERVIEW

Confidentiality is an issue that cuts across other Plays. Your practice will need to incorporate management of potentially confidential drug and alcohol use information into the design of every Play. Confidentiality considerations will impact flow, Electronic Health Record (EHR) integration, referral relationships, and other decision points throughout your preparation for implementation. There are state and federal laws and regulations that govern confidentiality of alcohol and other drug use information. Your site must be savvy about what does and does not apply to your identified population, and your specific organizational and staffing structure.

S·BI·RT for pediatric patients entails that routinely asking youth questions about substance use, and intervening as indicated, is a standard component of your clinical assessment. Screening that results in honest answers to these sensitive topics depends on trusting relationships between youth and provider, including trust that screening responses are confidential and not shared with parents. How do you explain this in advance to the minor as well as the parent so that the boundary is clear? How will you securely document screening results in the EHR or patient portal so that parents cannot access them? Will you follow up without indicating the specific nature of the concern? How will you protect the nature of the appointment? In some cases it will be necessary to share information with parents. How will your site determine when it is appropriate to break that confidentiality and disclose to the parent?


Purpose of Play 4
  • To understand confidentiality rules, regulations, and laws regarding alcohol and other drug patient information.
  • To explore confidentiality considerations by population.
  • To be clear in the site/organization’s policy regarding confidentiality of substance use information by population.
  • To decide how to communicate these parameters and to whom.
  • To decide if you will include a written confidentiality protocol in your policies and procedures.
Definitions The confidentiality protocol (verbal or written) is your site’s process for how to manage and protect the information about patients’ substance use.
Team members Practitioners can be particularly helpful in clarifying confidentiality responsibilities and protocols. Behavioral health and pediatric practitioner representatives can be key to this decision-making.
Measure(s)
  • Decision regarding confidentiality policy and protocol.
  • Protection of confidential information throughout the visit flow (including on post-visit print outs and throughout the electronic health record)
  • All staff know the boundaries of confidentiality and their responsibility for managing and protecting this information.

 


Recommended Approach

  • Review current policies and procedures about confidentiality involving minors’ behavior now,e.g., regarding sexual behavior, sexually transmitted diseases, depression, self-harm, and so on.
  • Review the information included in Appendix F and Appendix G regarding federal and state laws and consult New Futures to clarify questions.
  • Participate in peer learning opportunities to understand the decisions and experiences of other sites/organizations.
  • Develop a clear decision regarding confidentiality procedure/protocol. Consult legal counsel with any concerns about liability pertaining to your team’s decisions.
  • Confidentiality decisions should be incorporated into training and communications planning.
  • Decisions regarding confidentiality and informed consent policy for your organization’s S•BI•RT process may not be finalized until the end of the planning process as they will
    influence and be influenced by other Play decisions.
  • Finalize and disseminate confidentiality/privacy policy decision(s).

Keep In Mind

  • Berg v. Berg established legal precedent in New Hampshire regarding parents’ rights to their children’s clinical information. While the Berg decision did not pertain to S•BI•RT directly, it offers helpful guidance to physicians and substance use treatment providers, suggesting grounds for medical professionals to resist disclosure of children’s records to parents if in the minors’ best interests.
  • Federal confidentiality law pertaining to alcohol and other drug treatment information, 42 CFR Part 2, probably does not apply to your medical facility. It may apply to a specific embedded alcohol and drug treatment provider or program, but as a general medical facility, it is only the specialty treatment unit or specialty treatment personnel to which federal confidentiality is applicable, NOT the whole facility.

Corresponding Appendix Section(s)

Appendix F – S•BI•RT: Federal Alcohol and Drug Confidentiality Overview
Appendix G – S•BI•RT: Health Centers and Confidentiality Overview