In keeping with the guiding principles of systemic recovery transformation, these guidelines are intended to further promote family inclusion and leadership, while adhering to confidentiality laws and regulations.

Download Family and Confidentiality Guidelines

1. Statement

   The current standards of confidentiality and/or privacy regulations have long presented a barrier to family members and/or support persons of those receiving services from being fully included and/or recognized within the recovery process and the development of resilience and protective factors in children, adolescents and families. The complexities of the standards often make it difficult when service providers have to enforce the law.

   In keeping with the guiding principles of systemic recovery transformation within the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), these guidelines are intended to further promote family inclusion and leadership in all levels of care throughout Philadelphia’s behavioral healthcare system, while simultaneously adhering to confidentiality laws & regulations.

2. Context

   Involving family members or significant person(s) to participate in the recovery/resilience journeys of their relatives and friends when a family member is receiving behavioral health services help to speed recovery and resilience and increase recovery capital. There are, however, occasions when persons receiving services choose not to formally invite or approve the involvement of their families or other supporters. Under these circumstances, confidentiality regulations must be upheld.

   However, the absence of a signed release does not preclude the service providers from contacting the family or friends of service recipients in nonconsensual situations (55 PA Code § 5100.32). In the absence of a signed release, service providers may contact families and other supporters when the individual receiving services makes a credible threat of bodily harm to him or herself or to another individual. The service provider may only release the specific information pertinent to the relief of the emergency. If the individual is receiving addiction treatment services, the service provider may only disclose the threat anonymously to the subject of the threat or to the police.

3. Intention

   These guidelines are intended to convey the types and extent of communication that can occur between providers and significant others when a signed release of information has not been secured. They also are intended to reinforce the importance of family inclusion and leadership as an established pillar of system transformation. They will provide the means with which to provider agency staff on what is deemed as an acceptable form of inclusion within the realms of confidentiality.

Recommendations

It is recommend that the following practices be employed by provider agencies to manage collateral contacts with friends and family members of service recipients for whom there are no signed release of information forms. These guidelines are informed by the Philadelphia Behavioral Health Services Transformation Practice Guidelines for Recovery and Resilience Oriented Treatment (April, 2011). The following four guiding principles should be utilized by provider agencies when handling a contact without a signed release of information from the person receiving services:

1. Listening to Family Members, Key Allies and/or Significant Others without a Release

   1. There is no legal or clinical reason to refuse to listen to a family member or other significant person who may call to obtain information about the individual receiving services. In the case of an involuntary commitment of someone with a mental health challenge, 55 Pa. Code § 5100.31 (d) states: Nothing in this chapter shall limit the facility’s obligation to attempt to obtain social history and other records necessary to properly treat a person who has been involuntarily committed.

   2. Staff must still inform the person requesting information that they may not confirm or deny the presence of an individual receiving services within a program. This is especially true when the individual is receiving services for addiction challenges. In the case of an individual receiving care within a mental health facility, 55 Pa. Code § 5100.31 (g) states that the presence or absence of a person currently involuntarily committed to a mental health facility…may be released at the discretion of the director of the facility…when it is clearly in the person’s best interest to do so..

   3. Staff must inform the person(s) requesting information that the provision of general information about a behavioral health challenge is not an indication that someone is receiving care.

   4. Staff may inform the person(s) requesting information that they can listen to them.

   5. Staff should interact with family members or significant others who call seeking information in a professional, courteous and respectful manner.

2. Giving Resource Information to Family Members, Key Allies and/or Significant Others without a Release

   1. There is no legal or clinical reason to avoid giving resource information to a family member and/or other significant person. (i.e. the phone number of a support group, a source of information about SSI benefits, etc.)
   2. Staff must still inform the person requesting information, in general and at the onset of the conversation, that they may not give any information regarding any individual who may be receiving services. (Exceptions are contained in I and II above.)
   3. Staff may inform the person(s) requesting information about particular resources that may be of help and/or assistance to them and, in turn, provide information about that resource.

3. Nonconsensual Release of Information — (Breaking Confidentiality to Protect an Individual from Serious Risk of Bodily Harm or Death)

   1. Staff may and should release information without consent by talking to a family member and/or significant persons only when a release of information is necessary to prevent serious risk of bodily harm or death to the person receiving services or to others. Only specific information pertinent to the relief of the emergency may be released on a nonconsensual basis. (See 55 Pa. Code § 5100.32 and Section 2 above)

4. Nonconsensual Release of Information – (Breaking Confidentiality to Protect the Identifiable Victim of Credible Threat of Bodily Harm)

   1. Staff members have a legal duty to warn the identifiable victim of a credible threat of bodily harm when the individual receiving services is making the threat against a family member, friend, or another identifiable person, even if this breaks confidentiality. (See 55 Pa. Code § 5100.32 and Section 2 above)

* Note: While these guidelines are also generally applicable to family members and significant others of youth age 14 to 17 years old receiving services who have consented to their own treatment, parents or other legal guardians of children under the age of 14 have rights to information regarding treatment even without a signed release of information. See PA Act No. 2004-147, effective 2005, which governs the somewhat more complex confidentiality rights of minors 14 years of age and older.

Note: These Guidelines were reviewed by the Senior Attorney/Privacy Officer, City of Philadelphia Law Department, September, 2012

Added 10/05/2012 by OmiSade Ali, DBHIDS Deputy Commissioner