Critical Issue: Addressing Confidentiality Concerns in School-Linked Integrated Service Efforts
ISSUE: Schools and human service agencies increasingly are working together to meet the multiple needs of children and families through school-linked integrated services. One of the most common implementation issues faced by these collaboratives is addressing the need to share information about the people they serve. When confronting multiple and often confusing confidentiality provisions, which place constraints on the exchange of information, many professionals view confidentiality as a barrier to the delivery of services and ultimately to interagency collaboration. Yet addressing confidentiality concerns and developing guidelines for sharing information are essential tasks for collaboratives. "Confidentiality is neither an impenetrable barrier nor something which can easily be disregarded," note Greenberg and Levy (1992); "it is possible to develop means of exchanging information that are effective and practical on a wide scale, while still respecting legitimate rights to privacy" (pp. 1-2).
OVERVIEW: Collaboratives linking students and schools to integrated services recognize the importance of collective endeavor in meeting the range of needs of families and children and in promoting positive youth development. When collaborating to meet their mutual goals and provide services to children and families more effectively, school staff and human service providers often need to share information on common clients. The sharing of this often-sensitive information, however, raises a number of ethical and legal issues relating to confidentiality.
Judy Caplan, coordinator of school and family partnerships at North Central Regional Educational Laboratory, discusses the importance of sharing information yet maintaining confidentiality when providing services for children and families. [567k audio file] Excerpted from a videotaped interview with Judy Caplan (North Central Regional Educational Laboratory, 1997). A text version is available.
Soler and Peters (1993) describe several ethical reasons for protecting the privacy of children and families when implementing school-linked services: Confidentiality provisions help protect families from embarrassing disclosures, discrimination against themselves or their children, differential treatment, and threats to family and job security. Confidentiality provisions also may encourage students or families to take advantage of services designed to help them (Constantine, Aronson & Wilber, 1994).
Many of the legal protections to confidentiality are constitutionally based in the fundamental right "to be let alone" (Soler & Peters, 1993, p. 6). Right-to-privacy protections also are reflected in federal and state statutes, statutory privileges, agency regulations, ethical standards, and professional practice standards (Soler & Peters, 1993, p. 9).
A 1974 federal law, the Family Educational Rights and Privacy Act (FERPA), protects the privacy interests of students in elementary and secondary schools (and their parents) with regard to certain types of education records. FERPA requires that prior consent be obtained from the student (if 18 or older) or the student's parents before certain types of information can be released from school records. FERPA also gives parents and students access to records, along with the right to challenge the accuracy of those records and make necessary modifications. Changes to FERPA most recently were enacted as part of the Improving Schools Act of 1994, resulting in the issuance of final regulations of FERPA by the U.S. Department of Education. These amendments help promote information sharing by educators (Laney, 1996).
While FERPA legislates the sharing of education records, other federal statutes and regulations govern confidentiality of other types of information; these statutes and the regulations implementing them may affect the ability of health and social service agencies to share information with schools. In addition, service providers often adhere to formal or informal codes of professional ethics that influence their willingness to share information (Greenberg & Levy, 1992; Larson, 1992). For example, the American Psychological Association (1992) includes a section on Privacy and Confidentiality in its Ethical Principles of Psycholgists and Code of Conduct. Similarly, the National Association of Social Workers (1996) has a section on Privacy and Confidentiality in the Ethical Standards section of its Code of Ethics. All these issues must be considered when schools and service agencies collaborate for information sharing.
As part of their implementation efforts for school-linked services, schools and service agencies may convene a collaborative team that is charged with addressing confidentiality concerns, protecting the privacy of student records, and developing guidelines for information sharing. Because educators, service agencies, and individual service providers may have different perspectives and professional obligations with regard to confidentiality (Office of Educational Research and Improvement, 1996), specific confidentiality concerns should be temporarily set aside until team members have developed a comfortable working relationship. At initial meetings, emphasis should be placed on a common basis of understanding and a shared commitment to the importance of information sharing (Greenberg & Levy, 1992).
Glenda Cochrum, coordinator of the Fulton County KIDS Project at Fulton County Schools in Hickman, Kentucky, emphasizes that members of collaboratives need to develop a working relationship and cultivate a level of trust before addressing confidentiality concerns. [819k audio file] Excerpted from the video series Schools That Work: The Research Advantage, videoconference #8, Integrating Community Services (North Central Regional Educational Laboratory, 1992). A text version is available.
After a sense of trust has developed, collaborative partners are ready to discuss the implications of confidentiality for their work together. Partners determine who to involve in the information-sharing process, clarify reasons to share information, identify and address legal issues relating to confidentiality, and identify and address nonlegal issues that may present barriers to information sharing (Greenberg & Levy, 1993).
At this point, collaborating partners will need to review existing statutes, regulations, and court decisions that clarify the laws regarding confidentiality; determine types of data to share and for what purpose; decide how information will be stored; and specify who will have access. Special attention should be paid to information sharing between schools and the juvenile justice system when juvenile delinquency is involved. The partners then can establish policies and procedures for sharing information that balance the legal and ethical privacy rights of individuals and the partners' needs to share information on common clients. The development of policies and procedures for the exchange of information should involve at least one attorney (Greenberg & Levy, 1992).
Next, partners need to determine a method for obtaining informed consent to share client information. The most common method for obtaining this information is through a release form, which is signed by the client or by the parent/guardian if the student is a legal minor. In some special situations involving the provision of medical services to students, however, adolescents may sign the release form.
Judy Caplan, coordinator of school and family partnerships at North Central Regional Educational Laboratory, describes the purpose and use of release forms. [315k audio file] Excerpted from a videotaped interview with Judy Caplan (North Central Regional Educational Laboratory, 1997). A text version is available.
Partners need to decide whether each agency will use its own release form or if a common release form will be developed for the collaborative (Soler & Peters, 1993; Greenberg, 1992). In addition to developing release forms, partners need to develop procedures for presenting the release form and obtaining consent from clients. Also to be designed is a systematic way to keep clients continually informed about what information will be shared, with whom, and for what purpose. Partners then should educate themselves regarding the circumstances under which information may be shared without prior consent, particularly when there is duty to warn in order to protect an individual's health or safety.
Determining security procedures for maintaining records and information is another important task for the collaborative. Schrier (1980) suggests that every agency "designate responsibility for managing its record system to an individual and institute such safeguards to security as locked files and requirements for verifying the identity of persons releasing and requesting information" (p. 455). Because client information typically is maintained on computer databases, agencies should develop security procedures to safeguard automated data so that confidential information is not disclosed improperly. Greenberg and Levy (1992) suggest that service providers should consider limiting the data in the system and the data that can be retrieved from the system. Partners also need to develop a system for documenting the disposition of requests to release information.
Everyone on the staff of schools that are part of collaboratives needs to understand confidentiality requirements. The professional development and support opportunities provided by schools should help school staff develop awareness of confidentiality requirements and procedures as well as sensitivity to client needs for privacy.
Resolving confidentiality issues when sharing client and family information has been identified as one of the major factors essential to successful implementation of collaborative school-linked service efforts (Wang, Haertel & Walberg, 1995). But when collaboratives are armed with an understanding of the power of sharing information as well as the ethical and legal ramifications of doing so, they should be able to create information-sharing policies and procedures that will enable them to serve children and families more effectively while protecting privacy rights.
ACTION OPTIONS: When a school is part of an integrated services collaborative, school staff and the collaborative team can take the following steps to coordinate efforts so that confidentiality issues are addressed and guidelines for sharing information are used effectively.
School Staff (including administrators, teachers, social workers, nurses, psychologists, counselors, library media specialists, and support personnel):
Collaborative Team (comprising educators, service providers, high-level education and agency officials, parents, community members, legislators and judges, attorneys, and management information system staff):
IMPLEMENTATION PITFALLS: One of the major pitfalls encountered by collaborative partners is tackling issues of confidentiality before trust has been developed within the collaborative. Greenberg and Levy (1992) note:
"Working on confidentiality and information sharing should not be among the first tasks of a developing collaborative effort. Because the subject is complex and a mutually agreed upon approach for sharing is likely to entail compromises, it is important to have working relationships and commitment to joint efforts already firmly in place. The stronger the personal relationships among participants, the more easily confidentiality issues can be addressed. Holding off a bit on the time when the issue is tackled allows a base of trust, mutual understanding, and experience working together to be built." (p. 7).
Another pitfall is that participating institutions and agencies may be reluctant to share information with other agencies because of "feared loss of turf control, distrust of other professionals' use of confidential information, and ethical and legal concerns (including fear of lawsuits) when information leaves traditionally closed systems" (Crowson & Boyd, 1995). Some agencies even may withhold client information. To address these issues, collaboratives must emphasize the importance of trust and communication among partner members. Hendrickson and Omer (1995) state:
"While confidentiality must be ensured, a priority of comprehensive service schools should be to improve communication within and between agencies, work to change conditions that impede information sharing, and monitor the communication process continuously." (p. 159)
A third pitfall is laws that impede the sharing of information. Such laws often can be altered by legislative action to ease the process of sharing information without substantively changing existing protections. Sometimes laws affecting different agencies are inconsistent, perhaps simply because they were adopted at different times by different drafters. After reviewing such laws, legislators may act to reduce these inconsistencies, making it easier for collaborating agencies to adopt common procedures (Greenberg & Levy, 1992, p. 29).
Interpretations of laws also can impede the sharing of information. According to Laney (1996), educators may interpret FERPA restrictively and then develop correspondingly restrictive confidentiality policies:
"Many state and local educational agencies and institutions have been overly restrictive in their interpretation of FERPA or in their information release policies. Educators frequently decide to err on the side of caution by establishing policies recognizing a generalized right to privacy with regard to all information on students. Unfortunately, both inaccurate interpretations and restrictive FERPA policies pose significant obstacles to meaningful information sharing between agencies." (p. 1)
The rural or urban setting of the school may contribute to other pitfalls. A rural culture, for example, may pose difficulties for educators and service providers who need to distinguish clearly between their personal and professional roles and their respective sanctions. An urban culture may contribute to overly informal sharing of information that does not adhere to confidentiality guidelines.
Judy Caplan, coordinator of school and family partnerships at North Central Regional Educational Laboratory, explains how confidentiality issues may differ in rural and urban settings. [788k audio file] Excerpted from a videotaped interview with Judy Caplan (North Central Regional Educational Laboratory, 1997). A text version is available.
There are rare instances when a parent or student does not want to give consent. In these situations, the counselor or service provider should try to determine, without putting pressure on the individual, why the person is refusing to give consent and then seek review of this concern by the involved partners. One approach is to hold an interagency team meeting in which a caseworker presents information about the nonconsenting individual or family but withholds all identifying information so that it is a generic case. With this approach, the caseworker can receive the group's consideration and advice without breaching confidentiality (Greenberg & Levy, 1992). Some confidentiality statutes provide for duty to warn, or sharing information when necessary to protect the health or safety of an individual in an emergency situation.
DIFFERENT POINTS OF VIEW: Some stakeholders believe that sharing a client's personal information with service providers is not really breaching confidentiality but is a means of providing needed services effectively and efficiently to the client.
Others may believe that information should never be shared among service providers because of the possibility for leaks of potentially damaging information, particularly when computers are used to store personal information about clients.
ILLUSTRATIVE CASES: The following examples illustrate how several programs of school-linked integrated services have approached confidentiality.
Confidentiality Issues at Fulton County Schools, Hickman, Kentucky
Confidentiality Issues at New Beginnings Center for Children and Families, San Diego, California
Confidentiality Guidelines of Youth Services Teams, Linn County, Oregon
Council of Chief State School Officers
1 Massachusetts Ave. N.W., Suite 700
Washington, DC 20001-1431
(202) 408-5505; fax (202) 408-8072
Family Policy Compliance Office
U.S. Department of Education
600 Independence Ave. S.W.
Washington, DC 20202-4605
National Center for Service Integration
c/o Child and Family Policy Center
218 Sixth Ave., Suite 1021
Des Moines, IA 50309-4006
(515) 280-9027; fax (515) 244-8997
Contact: Charles Bruner, Director
E-mail: CFPC@earthlink.net or HN2228@handsnet.org
This Critical Issue summary was written by Robin Fleming and Stephanie Lubin, program specialists with the Center for School and Community Development at North Central Regional Educational Laboratory.
Date posted: 1998