Confidentiality

Common Breaches of Confidentiality

-The identity of the client -Communication between patient and professional -Records of the therapy communication -Records of diagnosis and treatment -Disclosing sufficient information about a client to deduce the identity -Leaving messages with clients -Someone overhearing the therapy session -Misplacing the clinical record

What do providers have to do under HIPAA

1. At intake must provide a notice of Privacy practices that describes how their protected health info (PHI) will be used 2. must document consent about the use & disclosure of PHI described in notice of Privacy practices (NPP) 3. must document any disclosures beyond that describe in the NPP

How is Texas law more restrictive than HIPAA with communication

1. allows disclosure to another professionals under the professionals direction who participate in assessment & treatment 2. still must get client's permission to disclose to other treatment professionals (Texas Trumps HIPAA)

"may" disclosure confidential Info outside of court

1. client consent 2. parent of a minor consent 3. legal guardian of client 4. billing or collections agencies (assumed on informed consent) 5. others involved in patient care if under the professional's supervision 6. gov't agency if required by LAW (ie CPS) 7. medical or law enforcement if probability of imminent harm 8. Audits, as long as auditor protects identity

Texas law- what is confidential information (or the elements of confidentiality)

1. communications between therapist & client 2. records of the identity 3. diagnosis 4. evaluation 5. treatment of a patient that are created or maintained by a professional

What do providers have to do under HIPPA

1. notify client's about their privacy rights & how their info can be used 2. adopt & Implement privacy procedures for it's practice, hospital, or plan 3. train employees so they understand procedures 4. designate someone to be responsible for procedures 5. secure client records so they are not readily available to those who do not need them

Consequences of Improper Disclosure

1.Clinical: damage to therapeutic relationship 2.Legal -Injunction and relief in civil court

Allowable Disclosures of confidentiality inside court?

1.Court proceeding in which the patient waives the right to confidentiality 2.Court proceeding affecting the parent-child relationship 3.Criminal proceedings 4.Patient sues professional (malpractice) 5. Licensure complaints by the patient 6.Collections proceedings 7. Involuntary commitment proceedings

Allowable disclosure in legal proceedings

1.If client sues the professional 2.License revocation hearing 3.Collections 4.Parent-child relationship 5.Any criminal proceeding 6.Involuntary commitment proceeding

Common Acceptable practices for confidentiality with couples & families

1.Treat each like an individual client =Information is not divulged without consent ="Secrets" help therapist to understand process =Encourage members to share "secrets" 2.Treat the couple or family as the client =Avoid receiving individual confidences =Conducts only conjoint sessions =Therapist discourages unequal alliance 3.Therapist reserves judgment about whether to maintain individual information Information shared individually may be shared in joint sessions Therapist's judgment Attempt to perceive the situation from the person unaware of the secret. Is the secret relevant for the person unaware of it? Sensitivity to the timing and consequences of the disclosure.

Disclosures NOT permitted

Subpoena -Is it a valid subpoena? -Is the information relevant to the action? -Confidentiality rules apply -Civil court: need patient permission =Unless patient sues professional = Malpractice claims =License revocation =Collections suit -Civil court: do not need patient permission Parent-Child relationship Criminal court: do not need patient permission

When is it permissible under HIPAA to discuss a patient

when consulting with another health care provider about a patient's treatment

Who "owns" the right to confidentiality

(1) the patient; (2) a person listed in Section 611.004(a)(4) or (a)(5) who is acting on the patient's behalf; or (3) the professional, but only on behalf of the patient. (b) The authority of a professional to claim the privilege of confidentiality on behalf of the patient is presumed in the absence of evidence to the contrary.

HIPAA Confidentiality Stardards

(Health Insurance Portability and Accountability Act)1996 -HIPAA establishes national minimum standards for confidentiality of health information. -If state standards are below HIPAA, must follow higher standards. -If state standards exceed HIPAA, must follow state standards.

Consequences of Non- Compliance with HIPAA

(under HHS' office for Civil Rights (OCR) over sees & enforces the new federal privacy regulations). 1. enforcement will be primarily complaint- driven. OCR will investigate complaints & work to make sure that consumers receive the privacy right & protections required under new regulations. 2. when appropriate, OCR can impose civil monetary penalties for violations of the privacy rule provisions

Break of Confidentiality when required by law

-If you suspect child abuse (§ 261.101) -Abuse of elderly or disabled (§ 48.051) -Abuse in a health care facility (§161.132) -Sexual exploitation by a mental health provider (§ 81.006)

HIPAA's Patient protections

-Patients' access to records -Notice of privacy practices -Personal health information may not be used for unrelated purposes (marketing) -Communications must remain confidential -Establishes standards for electronic billing -Complaint procedure

Which providers are affected by HIPAA

-The Administrative Simplification standards adopted by HHS under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) apply to any entity that is: -a health care provider that conducts certain transactions in electronic form (called here a "covered health care provider") -a health care clearinghouse -a health plan