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Mark I. Soler
Alice C. Shotton
James R. Bell
National Center for Youth Law ,
March 1993

EXECUTIVE SUMMARY

Fragmentation of services for children and families at risk has become one of the tragic hallmarks of our society. In response, in recent years there has been a remarkable growth of interest in interagency collaborations to provide more comprehensive and more effective services.

Discussions of interagency partnerships have noted seveml barriers to the development of collaboration efforts. Some of the most frequently mentioned are the confidentiality statutes and related regulatory provisions that appear to prohibit or restrict agencies from working together. On their face, such provisions limit the flow of information (and therefore, potentially, service efforts) from one agency to another, and many administrators regard them as major impediments to interagency efforts. On the other hand, such provisions are obviously not insurmountable obstacles to collaborative work, since agencies in communities throughout the country have formed successful partnerships.

This project is an assessment of confidentiality restrictions to determine whether they constitute real barriers to interagency collaboration efforts. The research focused on federal statutes and regulations, as well as those of Califomia, Iowa, New York, and Washington. The investigation included legal research, interviews with agency administrators and personnel, and site visits.

The report concludes that confidentiality restrictions are not significant barriers to interagency collaborations.

The report first analyzes the interests of children and families in protecting information from disclosure. These interests include:

• the core interest in privacy (the right to be let alone);
• avoiding embarassment and humiliation from disclosure of personal or family problems;
• avoiding exposure of information that is inherently inflammatory (such as allegations of child abuse or mental instability), even if the information is unproven or inaccurate;
• protecting personal security (such as the location of victims of domestic violence);
• protecting family security (such as citizenship status, for immigrant families);
• protecting job security, particularly when personal problems may have no connection with actual job performance;
• avoiding prejudice or stereotyped responses as a result of information or family income level, medical status, or past difficulties;
• preventing denial of discretionary services;
• encouraging adolescents to seek medical care; and
• reestablishing privacy boundaries for children, especially after abuse or multiple out-of-home placements.

Balanced with these interests in privacy are the interests of agencies in sharing information. In many situations, children and families share these interests in the effective and efficient provision of services. The interests of agencies (and families) include:

• conducting comprehensive child and family assessments and evaluations for services;
• providing children and families with all necessary services;
• coordinating service plans and strategies and avoiding duplication of services;
• monitoring the provision of services;
• making services family-focused;
• allowing research on community needs and program effectiveness;
• promoting public safety (e.g., by sharing information about potential child are workers regarding prior criminal convictions); and
• securing full reimbursement from federal and other funding sources for services provided.

The report reviews privacy protections and confidentiality restrictions in federal and state constitutions, statutes, regulations, and agency practices, as well as those in various professional standards. It finds that, from the Constitution to the agency manual, confidentiality restrictions are not absolute, but instead balance individual interests in privacy against agency interests in pronding effective services.

The report then describes the many means by which agencies share information. Some information, such as that which does not identify specific individuals, is not confidential at all and may be shared freely. Other very basic information, like educational "directory information", is also not considered confidential.

Much information-sharing takes place through informal exchanges, often over the telephone. This generally occurs between workers in different agencies who have developed a high degree of trust and cooperation. It is usually limited to verbal exchanges of information: if documents need to be shared, a written release or other formal mechanism is required.

In addition, most statutes explicitly authorize a certain degree of information sharing for such purposes as administration of the program, audits, determinations of eligibility for services, medical emergencies, and investigations, prosecutions, or civil or criminal proceedings related to administration of the program.

Virtually all statutes authorize information-sharing with the consent of the client . Such information-sharing generally requires a written release, specifying the name of the person who is the subject of the information, the name of the person or agency sharing the information, the name of the person or agency with whom the information will be shared, the reasons for sharing the information, the kind of information that will be shared, the signature of the person giving consent, the date the release is signed, a statement that the release may be revoked at any time by the person giving consent, an expiration date for the release, and a statement that the person giving consent in entitled to a copy of the release.

The report also discusses interagency agreements, memoranda of understanding, contracts, court orders, and other mechanisms for sharing information among agencies . The report discusses several examples of each type of mechanism, and describes a program in Iowa that uses several mechanisms simultaneously. The report also covers confidentiality in aggregate information systems, particularly automated information systems containing identifiable information. Using such systems while ensuring client privacy requires clarifying the purposes of the information system, limiting the information in the system to that truly needed to fulfill those purposes, securing the cooperation of multiple agencies in developing and operating the system, providing adequate notice to children and families that information about them is being put into an information system and will be accessible to others for specific purposes, maintaining several levels of security in the system, and providing adequate training for staff.

The report then discusses methods of protecting confidential information in practice , including staff training and training materials, staff oaths and other restrictions, and the roles of agency counsel and other "gatekeepers."

Finally, to assist agency administrators and personnel, agency counsel, legislators and other public officials, policymakers, and child advocates in working on confidentiality issues, the report includes in the appendices an extensive set of statutes, regulations, portions of agency manuals, consent forms, interagency agreements, and similar documents.

Copies of this report are available for S35.00, including postage and handling, from the National Center for Youth Law , 114 Sansome Street, Suite 950, San Francisco, CA 94104, (415) 543-3379.

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