2010 Virginia Sexual and Domestic Violence Action Alliance

1. Model Policies on Confidentiality and Record-Keeping 2010 Virginia Sexual and Domestic Violence Action Alliance

2. Thank you for downloading the Model Policies on Confidentiality and Recordkeeping Training Module. Before we get started, we’d like to encourage all the participants to take the Pre-Test associated with this module. Please visit http://tiny.cc/MPCR_PREor use the printed version of the test that was sent with the training module materials. This should only take a few minutes. Thank you! Click to advance to the next slide

3. Model Policies are the roots to ensure stability

4. Course Objectives: • Become familiar with Federal, State, and Accreditation requirements on confidentiality and recordkeeping. • Discuss “best practices” in order to enhance confidentiality and recordkeeping procedures. • Analyze/evaluate effectiveness of current policies and practices.

5. Brief History In the early days of the sexual and domestic violence movements, maintaining confidentiality was relatively simple – no information was disclosed to anyone.

6. Brief History collaborate Violence Against Women Act Sharing information -- even identifying information -- with prosecutors, law enforcement, social services and health care providers became the norm – victim services other allied professions courts law enforcement prosecution

7. sometimes to the detriment of victims.

8. Confidentiality Persons accessing sexual and domestic violence services expect confidentiality. • State and federal laws identify • information that must be protected, • information that may be shared, • when information may be shared and • when information must be shared.

9. Model Policies Staff working in programs must have clear guidelines or model policies - • how to properly handle identifying information, • what to do when confidentiality is breached, • exceptions to confidentiality and • how to respond to requests for confidential information. Record-keeping practices are an integral part of confidentiality.

10. Basic Philosophy of Empowerment asks… What does a person accessing our services want us to do?

11. Scenario

12. Scenario Diana has a protective order that prohibits her live-in boyfriend from contacting her. Last night he went to her house and assaulted her. The police arrived after he had left and she went to the shelter with nine year old, Mia. She did not have a positive experience with the responding officer and has not been successful in finding out if her boyfriend was arrested. She has asked you, the advocate, to assist her in calling the officer to find out if he was arrested. The officer is angry that Diana let the batterer in her residence and suggests that she is mutually responsible for the abuse. Click to advance to the next slide

13. Should you, the advocate, be aware of any laws prior to taking action on behalf of the client? What agency guidelines or policies should be in place to protect the client? What would an advocate who works in your agency do? Assess the following: Click to advance to the next slide

14. Laws and Accreditation Standards External Communication • When requesting technical assistance for a client from the Virginia Sexual and Domestic Violence Action Alliance or any other agency, no personally identifying formation is provided unless the client has signed a time limited consent form. VA Code §63.2-104.1B • The agency does not confirm or deny to any party, including the media, that a person has accessed agency services, unless the client has signed a time limited consent form. VA Code §63.2-104.1B • The agency has a policy addressing Child Protective Services reports. VADVAA Accreditation Manual Section V, Item 7 Click to advance to the next slide

15. Scenario Two months have gone by and Diana has left the shelter but still attends weekly support groups. She has shared in group that she might do harm to herself or her child. The local police department has received a missing persons report for Diana. The officer who brought Diana to the shelter two months ago, calls to find out if Diana is still at the shelter or if the shelter knows how to contact her to determine if she is missing. The officer becomes frustrated when you explain that you cannot confirm or deny whether she is staying at the shelter. He says that any information you give him will be kept confidential and not shared with the person making the missing persons report. Click to advance to the next slide

16. Laws and Accreditation Standards • Staff protects the confidentiality and privacy of clients by not discussing clients with one another if another person can overhear the conversation. VA Code §63.2-104.1 • The agency has a policy addressing Adult Protective Services reports. VSDVAA Accreditation Manual Section V • The agency has a policy that includes what to do if a client exhibits or describes a clearly defined threat (a specific plan) of suicide, homicide, or imminent danger of serious bodily harm to her/himself or an identified person. VSDVAA Accreditation Manual Section V, Item 7 • The agency has a policy prohibiting staff, who are also employed at an allied agency, from sharing client information with that other agency even if that other agency is also working with the client, unless the client has signed a time limited consent form. VA Code §63.2-104.1 Click to advance to the next slide

17. Mandated Reporting Should you talk with Diana about her comments about hurting herself and her child? Should staff have a discussion around mandated reporting? Should staff know who is a mandated reporter? What procedures are in place for making reports? Click to advance to the next slide

18. Mandated Reporting Here are the guidelines on responding to suspected child abuse and neglect: All Sexual and Domestic Violence Agencies should have in place a protocol to guide staff in responding to child abuse and neglect. Protocols should define child abuse and neglect. Protocols should clearly identify staff/positions considered mandatory reporters. Protocols should identify safety planning options for parents and children or youth. Click to advance to the next slide

19. Telling Secrets • Think of a secret in your life. • Write down one or more reasons why you might reveal this secret to someone. (You will not have to reveal the secret.) • What were the reasons? • Write them down. • Share with the group or partner. Click to advance to the next slide

20. Telling Secrets • What would it feel like if the person you shared a secret with revealed it without your permission? • Write down a list of those feelings. • What might be the consequences of telling this secret to others without permission? Click to advance to the next slide Adapted from PATH. Ensuring Privacy and Confidentiality in Reproductive Health Services: A Training Module and Guide. Washington, D.C.: PATH (2003).

21. Consequences • Isolation • Death • Termination of job • Exiting from a shelter • Homeless • Loss of dignity • Re-victimization • Negative labeling • Criminal consequences • Loss of custody of children • Fear of….

22. Scenario

23. Scenario – Informing Clients “I came to the shelter and they gave me 10 pieces of paper to sign and I have no clue what I’m suppose to do with them. They say something about confidentiality but what does that mean? What do I do with this stuff? Do I need to take them to a lawyer before I sign them? Does this mean I can’t tell my family where I am? I’m very confused with confidentially and what it means. This is too overwhelming!” Client Karen

24. Informing Clients How do you explain confidentiality? Do you talk about how people are affected, and the consequences of breaking confidentiality? How is confidentiality shared and appreciated by someone with limited English proficiency? Are there any other considerations that might be important? Click to advance to the next slide

25. Informing Clients The Agency may only release client information with the informed, written reasonably time limited consent of the person. VA Code § 63.2-104 VSDVAA Accreditation Manual Section V, Item 5 Each person who signs a consent form must receive a copy of the signed consent form. VSDVAA Accreditation Manual Section V, Item 5 Agency staff reviews the agency confidentiality policy with each person accessing services. VSDVAA Accreditation Manual Section V, Item 8 The agency does not share client lists with identifying information with others outside the agency and does not have these lists visible to those entering a workspace. VA Code § 63.2-104-1 Click to advance to the next slide

26. “I’ve been working at this program for about three months. I was instructed to write down everything the client does. Today when I got to work, I was told that there was a subpoena and that I may have to appear in court. I’m scared. Nobody’s told me anything else. I don’t want to get any clients in trouble. I keep going over in my head what I might have done wrong. I got a call from the nurse at the local family clinic and gave her some client information. I was invited to participate in a SART meeting last week and I remembered to take the files of a client that I thought might be important to the discussion. No one told me not to. This is overwhelming!” New Advocate Lillian Scenario – Informing New Hires

27. Informing New Hires How do you train new hires on the complexities of confidentiality? What process is in place for staff who have questions about procedures or are in an emergency situation? Is this process recorded in the policies or is it “common knowledge”? Are there any other considerations that might be important? Click to advance to the next slide

28. Informing New Hires • The agency includes confidentiality as part of a all new staff/volunteer/intern orientation. VSDVAA Accreditation Manual Section III VSDVAA Accreditation Manual Appendix II • The agency has a written policy on responding to subpoenas and court orders for client or agency information that includes the reasonable steps the agency will take to protect the privacy of the information. The agency will make reasonable attempts to provide notice to victims affected by the disclosure of information. VSDVAA Accreditation Manual Section V, Item 7 VA Code § 63.2-104 .1 • The agency confidentiality policy addresses how the agency will respond to attempts to deliver subpoenas and court orders, warrants or other legal documents to clients. VSDVAA Accreditation Manual Section V, Item 7 Click to advance to the next slide

29. Highly Recommended • The agency does not disclose personally identifying client information via email or instant messaging between staff and another agency. • The agency works with each client to determine a “reasonable length of time” for the consent for release of information (consent form) based on her/his circumstances and/or the purpose of the release. • Consent forms are not valid without an expiration date. • The consent forms allow a client to choose to release information by date range and/or by topic for a meeting or specific conversation. Click to advance

30. Highly Recommended • The agency consent form makes it clear that someone’s medical, HIV/AIDS status, and alcohol/drug information are not part of the release unless the client gives specific written consent to do so. • The agency’s CPS and APS policies address when a report is to be made, who made it, exceptions to making a report, if any, and includes steps to inform the parent/victim/client that a report will be made. • In the event of a client’s death or incapacitation, the agency does not share information about the client without the prior, informed, written consent of the client. Click to advance

31. Record-Keeping

32. Keeping Information Secure Gender Race Person Receiving Services Type of Violence Perpetration Information Relationship to Victim Consent Form Medical Release Form Visitor’s Confidentiality Form Children Parental Supervision Form

33. Laws and Accreditation Standards • All client files are kept in a secure locked area. VSDVAA Accreditation Manual Section V, Item 2 • The agency has a written procedure that describes what it is/is not to be kept in client files. VSDVAA Accreditation Manual Section V, Item 7 • The files of client’s children are maintained in the same appropriate record-keeping manner as the adult clients’ files. VSDVAA Accreditation Manual Section V, Item 1 Click to advance to the next slide

34. Laws and Accreditation Standards • Client files that are stored on computers are password protected. VSDVAA Accreditation Manual Section V, Item 3 • The agency does not store personally identifying client information on any portable device, including but not limited to a laptop, Blackberry, external disk drive, flash drive, etc. VSDVAA Accreditation Manual Section V, Item 3 • The agency may not enter any personally identifying client information in any third-party databases, including, but not limited to, HMIS. VA Code §63.2-104 VSDVAA Accreditation Manual Section V, Item 6 VAWA Section 3 Click to advance to the next slide

35. Highly Recommended • Written procedures on how client files are to be treated • Clients have the right to review their files. • The agency makes a copy of the file for the client. • The agency keeps a “sample” file to show funders. • Client files and other written documentation contain limited information. • Agency logs do not contain personally identifying information. • Agencies must define the purpose of written internal agency communication • Written record retention procedure • The agency creates participant codes when using Vadata • Confidential information is not stored on any computer unless safeguarded. Click to advance

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