March 18, 2020

Cases have recently arisen where clinical social workers have been asked to disclose the names of their clients to public health officials, to assist in tracing exposure to the novel coronavirus.

The social worker's responsibility in this instance includes aspects of the HIPAA Privacy Rule, NASW's Code of Ethics, and local laws including licensure rules, health care confidentiality, and public health regulations. We will outline here how these national rules are likely to apply.

The Short Answer

HIPAA

As a general rule, HIPAA prohibits disclosure of protected health information without the prior consent of the client. The HIPAA Privacy Rule identifies a number of situations where this prohibition does not apply. However, if the state's privacy law is more protective than HIPAA, the state's restrictions on disclosure of protected health information will continue to apply.

HIPAA permits disclosures:

Ethical Considerations

The Code of Ethics strictly protects client confidentiality. While several provisions of the Code arguably permit the public health disclosures described above, disclosure even of a client's name might be viewed as a breach of confidentiality. If disclosure is necessary:

 

 

Some things to keep in mind as you sift through the information available.

When a crisis occurs, people will react swiftly to restore equilibrium.  Therefore, people often think concretely making simplistic solutions appealing because they tell people exactly what to do and not do. Unfortunately, the uniqueness of every person and his or her situation makes this strategy difficult. I always tease my students in class "we have a standardized protocol for treatment for most health and mental health problems, so the day you meet a standardized client, bring them to me as I have the protocol." Usually we have a good chuckle and get down to figuring out how the standardized protocol can serve as a temp-plate for ideas that can be quantified to help the client. With handling the events resulting from COVID-19, strategy and expert evidence-based information can be examined in a similar way.

 

One of the reasons I am proud to be a social worker is that the basic premise that underlines treatment is two-fold: 1. "Start where the client is" and 2. Take into account the "person-in-situation" and "person-in-environment."  

As I have listened to the news and read the advice of experts, I always hear my social work principles echoing in my ear.  To discern what information and strategy is best for myself or for others I am trying to help, I always keep the following in mind.  No one is ever going to have all the answers on how to best address a situation. Standardized protocols consist of educated, evidence-based strategy based on data that are always evolving. So much of what we learn when adapting evidence-based recommendations, especially with this unprecedented pandemic, is "learn as you go." This makes it so important for all individuals, especially faculty and students to take "advice on coping" or how best to "balance it all" as just that "advice." 

As professionals, we can use the skills we learned in college and teach our students to examine this information critically along with the credibility of the source.  Once done, apply what works best for you in your situation. I do have one concern with this; however, and that is be careful not to be too close to it to be objective, so when in doubt we all could use the advice of an objective professional who is sensitive to you and your needs.  

 

I know you have heard it repeatedly, that "you are not alone in this, we are in it together." This is true as a general statement, but with that said, you are unique and so is your situation. Social workers can provide an excellent resource for people struggling with how to take the professional evidence-based recommendations and guidelines and start where the client/person is and relate this information directly to the "person-in-situation" or "person-in-environment" perspective.

Times and situations change and this can be a perfect opportunity for generalizability and taking what strategy and evidence-based information available that can be critically examined and applied for what constitutes "best practices" for you, your family and those in your support system. 

"One size fit all" strategies remain limited to everybody being a similar size. Use your training to critically examine how to apply the most pertinent suggestions to your situation in the most productive way. Standardized protocols and recommendations have merit and provide the foundation for what we can do; yet, how it is applied requires application in the best way to benefit yourself and those around us. The phrase "you are not alone" means it is okay to ask for personalized professional help that can be objective in examining your unique situation. In social work practice, we always say "start where the client is" realizing your situation and needs may not fit a standardized mold. 

Lastly, in times of trauma, we need to realize that direction and guidance are the building blocks for application with the most effective outcome resting deep within finding the "goodness of fit." Every scientist knows even the best researcher can lose objectivity and in evidence-based applications, uncontrolled researcher bias is not your friend. 

As you read through the expert advice, determine how to best apply it to you, your family, and your support system. Most importantly, never forget that asking for professional help to assess your unique situation is not a weakness --it is a strength.   

NASW-FL has a supply of Florida Laws and Rules books  We were unable to use them because of the cancellation of workshops since March. The bound books contain Florida Statutes 456, 491 and Florida Administrative Code Rule Chapter 64B4. The statutes and rules will be updated this summer. 

If you would like to have a copy of the book, please email your mailing address to [email protected] and a copy will be mailed to you at no charge, while supplies last.