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Confidentiality

Hi Everyone:

My coworkers and I have a question about confidentiality:

We are a co-ed, short-term facility for youth aged 12 to 18.

We are again facing a concern that has arisen several times in the past. We occasionally get youth in our program with communicable diseases, such as sexually transmitted infections and HIV. According to our confidentiality policy we are not able to inform the other youth or the youth's social worker when we have a youth with a communicable disease, even if we know that youth is participating in activities that could put them at risk of getting and passing on the communicable disease(s). We feel that the youth who are engaging in these activities are at risk of being harmed, as STIs and HIV are life altering, if not fatal.

Our intake package includes a paragraph stating that any residential facility has the potential to have youth who have communicable diseases and Youth Care Workers are trained in taking universal precautions. We also have discussions and do programming with the youth about communicable diseases and the precautions to use.

Our question is, if we know that a youth has engaged in an activity with another resident that has put him/her at risk of being infected with a communicable disease, who's responsibility is it to inform the youth, and who's jurisdiction would this fall under (i.e. the facility's or the Department of Community Services)?

Thank you in advance for your advice,
Patsy Thompson
...

Hi Patsy,

I would advise consulting with a legal advisor about whose "responsibility" it is, as well as the confidentiality matter. We experience the same issues and after we consulted with a lawyer we were much clearer on the issues. However, I would consider the responsibility to be that of the facility, assuming that the facility is responsible for the care of the youth as well as decisions that would normally have been made by a guardian (i.e. the facility acts as the guardian).

The confidentiality issues is certainly not a clear-cut issue, and there will be different opinions. I believe that the privacy of the youth in question is very important, but even more important the protection of the youth and others when there is imminent harm. Again, here a legal opinion would be most wise. Good luck.

Werner van der Westhuizen
Social Worker, South Africa

...

Hi Patsy
I am not sure where you are located. I am in Ontario Canada and it is my understanding that it is the responsibility of the medical profession (youth's medical doctor) and Public Health to investigate and report this to all other partners of the infected person - youth or adult. This would be done in the strictest confidence.

Best regards,

Nancy Russell
Manager, Youth Justice Programs
Central Toronto Youth Services
...

First of all I do not believe that one paragraph informing workers of Universal precautions is enough at all. I completely agree that this is such a difficult decision to be making obviously you are concerned about the health of other residents and people involved in these youths' lives.

However, ultimatly I believe the decision is theirs to make. Keep in mind that it is not just the youth who are HIV+ that are acting in a harmful way it is the others people who are being careless about their lifestyle who are being harmful. I believe that with workers that are able to connect to the youth who are infected, they will be able to help that youth to understand how to be more responsible for their actions or at the least be informative of their disease to those who may be at risk. I do not believe that it is the responsibility of workers to tell others about a youth's health concerns even if they are as severe as AIDS. It IS a worker's responsibiliy to teach, preach, and practice SAFE sex, drug use, and Universal Precautions and with the right technique the youth should follow suit.

Heather Abbott
...

Hi Patsy,
I am not sure where you are located and what provincial laws/statutes are pertinent in your area. However, I think your question and difficult situation should be looked at from both a moral and a legal view.

Morally, it is pertinent that the youth who is infected with the STI be responsible to not engage in activity of such a nature that would place others at risk. The conversation with this youth as they enter your facility is the most obvious place to start with the moral obligations (and I have the confidence that your staff is already doing this). Additionally, if the youth is not hearing your staff or following the basic moral standard of regard for humanity, I would wonder what the counseling target should be.

Legally, it is against the law to engage in activity that places another individual at sure risk of contracting the disease, if the victim is unaware of the STI and the carrier has full knowledge of the STI and its consequences. I believe this to be a Canadian Statute and others have been convicted. I would also recommend the limitations on confidentiality with children under the age of 18 years. I believe their guardian has the right to inform other (whether the guardian is an appointed director or natural parent) and I also believe confidentiality is not upheld when there is harm to self or harm to others being suspected. I would have to push the fact that harm to others, with the youth being aware of their condition, is such a case that confidentiality may be breached upon the youth engaging in activities that harm others. Confidentiality is also waived with knowledge/consent of the client.

I could fully be wrong on this and haven't had the opportunity to investigate it, as I just received this post and appreciate the grave significance. Therefore I didn't want to delay a response. I hope you are able to resolve this issue quickly!

I am a Child Protection Worker in British Columbia and the issue of confidentiality is a daily occurrence in our work. I would hasten to say that if my client was engaging in activity that put others at risk, I would be informing them that if necessary I would be informing potential parties to be exposed to such a life threatening possibility and the laws that prohibit a knowing/willing transferring of such a STI.

Cheers
Rosana
...

Patsy,
I think that if the risk of HIV infection is among the youth, the youth have the right to know. Without using names, I think you and your staff should find a way to warn and protect the other youth who are at risk. In my opinion, HIV infection is serious enough to breach confidentiality because it could in fact cause harm to another person.

If the client with HIV was to come in to the center with a knife and say that he/she was going to hurt someone, would it not be your duty to protect the other person at all costs? I think HIV clients should be thought about in the same context. I am only a student in my first of two years of Human Services, and I know I still have a lot to learn, but this is one topic I feel very strongly about.

I don't think the client with HIV should be allowed to participate in activities that may put others at risk, and still have the option for his/her diagnosis to remain confidential. If the client is being responsible about their diagnosis and is refraining from putting others at risk, there is no need to share his/her diagnosis.

Being informed about HIV and AIDS is very important for the youth in today's society, but they all deserve to make the choices in their own lives, whether they want to be safe or not. If they are doing everything they can to protect themselves that is awesome, but if they are participating with someone who has tested positive, I believe they have the right to know.

I don't know if this helps at all, but again, it is my opinion and I am only a first year student.

Jacolyn
...

Hello Patsy,
You know, we all face this issue at least once in our career. However, it never gets resolved, I faced the same issue in 1999, I talked to a lot of pro. in the field, but still today in 2007 we hear the same issue. what it means to me is nobody wants to face it. Why if it is the legal issue, they do not put it in our books in college or university?

Why they do not put it part of the policy of the facility? Only saying this matter is confidential does not mean anything. Why is it not logically explained to students, workers, and maybe thr youth!! We are not supposed to release the issue to any youth, but we are aware of it when the youth come to our facility! And I am sure that all parties (members of the team) know about it. But I do agree with you, I think we should somehow bring up the issue so that no one gets hurt!!!

Ramin M.
C.C.C.W
...

I'm writing this email to thank everyone for their input on the issue of confidentiality (vis-a-vis AIDS, for example) that I inquired about back in May. I wanted to let everyone know that as a result of our enquiries, our province (Nova Scotia, Canada) has established a committee that will further review and refine the provincial policy for residential care regarding the concerns surrounding communicable diseases,including HIV and sexually transmitted diseases, that can cause life lasting harm.

We see this as a positive action plan and we on the front line have been invited to send on our thoughts in writing as well for the committee to consider when shaping the policy. This committee will be facilitated by the Provincial Ombudsman's office and will be comprised of representatives from various public and private sectors.

Again, I would like to thank everyone for their input and I'm looking forward to seeing the policy that will be developed by the committee.

Patsy Thompson
HomeBridge Youth Society
Nova Scotia
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