King County Information Sharing Resource Guide, 2 nd Edition

1. King County Information Sharing Resource Guide, 2nd Edition This guide is a tool developed by Uniting for Youth: A partnership of youth-serving systems in King County to provide basic answers to questions about the sharing of information between staff of various systems.

2. Who should use this guide? If you are a staff in a youth-serving system you may feel confused by information sharing and confidentiality laws. You might feel intimidated by these legal obligations and even be afraid to share information with others. This guide is designed to provide a better understanding of information sharing to support effective collaboration in juvenile dependency, juvenile justice, education, mental health, and substance abuse treatment systems in King County.

3. How to use this guide This guide has five broad content areas to help you better understand information sharing laws. • Information Sharing Principles • A Look at Roles • System Specific Information Sharing Guidelines • Decision Making Tree and Quick reference Grid • Appendices

4. A Special Note: It may be tempting to use the guide as a reference and only read certain areas as needed. In order to fully understand information sharing across systems and make the most of the guide we recommend that you read the entire guide before using individual sections.

5. Information Sharing Principles This section of the guide describes why and when information should be shared. When sharing information it is important to have a balance between protecting a family’s and child’s privacy and allowing systems to exchange information for coordinating services.

6. Roles and Responsibilities Each system is responsible to the child and his or her family, the community, and other stakeholders in very different ways. While you must consider your own responsibilities and requirements when sharing information it is helpful to know others’ goals to be able to effectively address natural conflicts when they arise.

7. A Look at Roles This section describes the roles and responsibilities of: Juvenile Probation Counselors, Division of Children and Family Services (DCFS) social workers, Juvenile Rehabilitation Counselors, School and Education Staff, Dependency Court Appointed Special Advocate (CASA) volunteers, mental health treatment staff, and substance abuse treatment staff.

8. Overview of Information Sharing Laws This section briefly identifies the laws that govern information sharing and confidentiality. The organizations and agencies that are covered by these laws and the guide are identified. Juvenile justice and care agencies are defined. Additionally, publicly-funded mental health and substance abuse treatment agencies are described. Finally, general information about Releases of Information is provided.

9. System Specific Information Sharing Guidelines This section provides detailed guidelines for each system of when and what information can be shared with another system. For instance… “When can the JPC share information with the DCFS social worker?” These guidelines can be used to understand what you are able to share with others. It can also help you understand what others are able to share with you.

10. Decision-Making Tree The Decision-Making Tree is designed to be used as a chart to aid you in determining when to share information.

11. Decision-Making Tree The first question to ask yourself when considering sharing information you have is… 1. Is the information I have necessary and relevant and important to the child’s and family’s case planning and services?

12. When information should be shared Ask the person making the request why the information is needed. You need to discuss what information is necessary and relevant to the scope of their work with the child. A clear understanding will help you disclose only the specific information for serving the needs of the child and family.

13. Next, ask yourself…. 2. Is it my information to share?

14. When it is not your information When it is not information that you or your organization originated it is best to direct the person requesting the information to the original source. There may be unknown factors that should be considered when releasing the information.

15. Then ask yourself… 3. Does the recipient have legal permission to obtain the information?

16. Proper Authorization The person requesting the information needs proper authorization for you to give them the information. Types of authorization include: • statutory (authorized by a law) • court order (authorized by a judge)

17. Release of Information (ROI) Another type of authorization is a release of information. This must be signed by the person legally allowed to share the information, usually the parent/guardian or the youth. The person signing must be giving informed consent for an ROI to be valid.

18. Informed Consent The person authorizing the release must fully understand: what information will be disclosed who will receive the information how it will be used

19. Special Considerations for Informed Consent When youth are represented by legal counsel the legal counsel should be involved when using a release of information to fully inform youth of possible legal consequences of information sharing.

20. Finally, ask yourself 4. Are there any reasons this information should not be released in this situation?

21. Consider Collateral Consequences • Information out of your hands can be used inappropriately. Once information is released it may be impossible to retrieve and it may be subject to redisclosure.

22. Professional Judgment It is essential that you use your best professional judgment when sharing information. Consult with your supervisor, records coordinator, or legal counsel if you are unsure about whether and how to share information.

23. Risks of Information sharing The information may be used in ways that could negatively effect the youth and their family. There could be: • Court sanctions • Placement changes for foster youth • Separation from family members • School suspension or expulsion • Peers or community members learning private information

24. Quick Reference Grid The guide contains a quick reference grid with a crosswalk of the givers and receivers for each system. It includes a very short summary of the information sharing allowed and the legal citation. There is a section of the grid for viewing on the next page.

25. Quick Reference Grid The givers of Information are listed in the vertical row The Receivers of Information are listed in the top row This box includes a thumbnail description of what schools can share with CASAs

26. Appendices The guide has 5 appendices to provide you with additional information and direct you to other resources.

27. Appendix A This is list of the federal and state information sharing and confidentiality laws described in the guide. There are website links to lead you to these laws. The electronic version of the guide contains active links that can be accessed.

28. Appendix B This includes acronyms and a glossary of terms that are in bold throughout the guide. Ever wonder what IEP, RSN, or PHI is? Appendix B will tell you.

29. Appendix C This has some Frequently Asked Questions. Did you ever wonder what is the difference between a RCW and a WAC? The answer is in Appendix C.

30. Appendix D • This explains the required elements for a Release of Information and a sample ROI is available. Get detailed information about what has to be included on an ROI.

31. Appendix E This provides additional resources. It includes King County and Washington State resources and links to the websites of the Uniting for Youth partners. There are national juvenile justice initiative website links to find out more about juvenile justice reform efforts. Finally, there are links to other information sharing guides and a information sharing tool kit .

32. Practice Scenario Next is a scenario included as opportunity for you to walk through the Decision-making Tree. • Refer to the Decision-making Tree on Page 14 when completing this activity.

33. Scenario You are a Juvenile Probation Counselor. You supervise a youth on probation that is also in foster care. Her Department of Child and Family Services (DCFS) Social Worker inquires about the youth's progress in mental health and substance abuse treatment.  You receive monthly status reports, however the youth does not want the social worker to get this information. What can you share with the social worker? What should you share with the social worker?

34. Walkthrough the Decision-Making Tree The first question to ask yourself when considering sharing information you have is… 1. Is the information I have necessary and relevant and important to the child’s and family’s case planning and services?

35. 1. The Answer is ‘Yes’ The information the Juvenile Probation Counselor has is necessary and relevant and important to the child’s and family’s case planning and services. As the legal custodian of the youth the social worker needs the mental health and substance abuse treatment progress information to ensure the youth is getting the care she needs.

36. Then, ask yourself…. 2. Is it my information to share?

37. 2. The Answer is ‘No’ The mental health and substance abuse treatment information was obtained during counseling services with the youth not created by the Juvenile Probation Counselor.

38. Examples of Possible Unknown Factors • In Washington, the age of consent is 13 years old. Washington law allows the youth to control his/her own health care information. • Substance abuse treatment information is protected by a federal law that prohibits re-disclosure (when an individual or organization discloses information or records it did not originate). 42 CFR, Part 2.32. Generally, this federal law does not allow youth agencies to re-disclose this treatment information with others even when Washington State laws does allow re-disclosure. This law continues to apply to the treatment information even when other youth systems such as schools or child welfare have it. Other systems may be unaware of this continued protection and the legal consequences of improper re-disclosure.

39. Decision-Making Tree Flow The Decision-Making Tree leads out of the question process when it is not your information. However, there are many circumstances that may lead to legal permission or requirements to share information that is not yours. This scenario is an example of when to continue considering legal permission/ obligations.

40. Next, ask yourself… 3. Does the recipient have legal permission to obtain the information? • Who is the requestor? • Why is this person requesting information? • How will the information be used? • Is the person presenting with proper authorization (statute, court order, ROI)? • Is the youth represented by legal counsel?

41. What is legally allowed Washington State law does allow the JPC to share documents retained in their records even if the agency was not the originating source of the document when DCFS is assigned the responsibility for supervising the youth. (see pages 22 and 30 of the Guide). Since federal law prohibits the re-disclosure of substance abuse records the JPC cannot legally re-disclose those records. In this scenario the JPC can legally re-disclose the mental health treatment records.

42. Finally, ask yourself 4. Are there any reasons this information should not be released in this situation?

43. Additional Considerations While the JPC can legally re-disclose the mental health records the youth has stated she does not want the information released to the social worker. Depending on other factors related to this youth’s situation the JPC may decide to withhold or release the information. As mentioned previously there may be conflicting considerations such as privacy, case planning, and safety issues to consider.

44. Benefits and Risks of Information Sharing Benefits may include: • Social worker may arrange additional support such as transportation, or foster placement located near counseling services Risks may include: • Youth could be placed in a more restrictive placement • Information could be shared with foster parent

45. Conclusion The Guide can be a useful tool but cannot provide answers for all the many complicated scenarios you will encounter. As you have seen information sharing is complex and challenging. There will always be new thought-provoking situations requiring in-depth review of information sharing and confidentiality laws. The Decision-making Tree can be used as a compass to help you through these information sharing mazes. Consultation with peers, supervisors, and legal counsel may be needed. We hope the Guide and this training have provided you with the opportunity to gain understanding and direction when navigating information sharing.

46. Printing the PDF You may wish to print the guide without the full-page pictures. In the print window this can be done by selecting “pages” in the “print range.” Enter 1-3,5-7,9-14,16-31,33,35-42,44 in the box next to “pages.”

47. Scenario Two A youth in the Juvenile Detention Health Clinic is presenting as disorganized (speech moves quickly through multiple topics), confused, with difficulty tracking (staying on topic during conversation). A drug screen is negative. Detention Health Clinic staff are unsure about the cause of the youth’s behavior. The youth is enrolled at a community mental health agency, and has a case worker and a psychiatrist. The mental health professionals in the Detention Health Clinic want to find out the youth’s1) psychiatric hospitalization history, 2) prescribed medications, 3) medication compliance, 4) treatment attendance, and 5) treatment plan. They need the information quickly in order to appropriately manage the youth.