Youth Quest

Youth QuestYouth Quest

Confidentiality TrainingConfidentiality Training

Section 1 - General RuleSection 1 - General Rule

General Rule DefinitionGeneral Rule Definition No acknowledgement or disclosure of any confidential No acknowledgement or disclosure of any confidential

information to anyone, without authorization.information to anyone, without authorization. One of the most difficult issues for many people who receive mental One of the most difficult issues for many people who receive mental

health services is the negative stereotypes and social stigma health services is the negative stereotypes and social stigma associated with mental illness, mental retardation, autism, and associated with mental illness, mental retardation, autism, and substance abuse. substance abuse.

In the course of providing services to our clients, we obtain a lot of In the course of providing services to our clients, we obtain a lot of personal information, some of it about very private aspects of their personal information, some of it about very private aspects of their lives. Unauthorized disclosure of this information can result in not lives. Unauthorized disclosure of this information can result in not only embarrassment and loss of trust but also in clients losing their only embarrassment and loss of trust but also in clients losing their homes or jobs. For these reasons confidentiality regarding personal homes or jobs. For these reasons confidentiality regarding personal information is protected by professional codes of ethics, by information is protected by professional codes of ethics, by regulations, and by state and federal laws. regulations, and by state and federal laws.

What does confidential What does confidential mean?mean?

ConfidentialityConfidentiality - The protection of private, identifying - The protection of private, identifying information. If information is accorded a confidential information. If information is accorded a confidential status, that status mandates specific controls, including status, that status mandates specific controls, including strict limitations on access and disclosure, so that strict limitations on access and disclosure, so that unauthorized persons cannot access it. These controls unauthorized persons cannot access it. These controls must be adhered to by those handling the information. must be adhered to by those handling the information. Confidentiality is an inclusive concept that is designed Confidentiality is an inclusive concept that is designed to assure that information will be used responsibly. It is to assure that information will be used responsibly. It is an integral part of professional codes of ethics that an integral part of professional codes of ethics that regulate the disclosure of information obtained in the regulate the disclosure of information obtained in the course of professional interactions.course of professional interactions.

Individually identifiable Individually identifiable informationinformation - -

Information, which makes it possible to Information, which makes it possible to identify an individual. This may be direct identify an individual. This may be direct (name, SS#, etc.) or indirect (information (name, SS#, etc.) or indirect (information from which one can reasonably figure out from which one can reasonably figure out the identity of an individual). the identity of an individual).

General Rule ------------- General Rule -------------

Youth Quest recognizes and adheres to this general rule. It should Youth Quest recognizes and adheres to this general rule. It should serve as the fundamental guideline to all employees. The rule is serve as the fundamental guideline to all employees. The rule is overstated to emphasize the importance of protecting people’s overstated to emphasize the importance of protecting people’s privacy and our role in safeguarding privacy.privacy and our role in safeguarding privacy.

It provides employees with a basis for decisions in situations It provides employees with a basis for decisions in situations where people are seeking information about individuals for whom where people are seeking information about individuals for whom we provide services or about whom we have information.we provide services or about whom we have information.

The emphasis here is on information related to people requesting The emphasis here is on information related to people requesting or receiving services. Administrative information and personnel or receiving services. Administrative information and personnel information can also be confidential, but are governed by different information can also be confidential, but are governed by different laws and rules.laws and rules.

General Rule ------------- General Rule -------------

Key Points:Key Points: 1) You know nothing, and you share nothing without an 1) You know nothing, and you share nothing without an

authorization.authorization. 2) You don’t admit knowing or not knowing the person without an 2) You don’t admit knowing or not knowing the person without an

authorization.authorization. 3) You do not share information with co-workers, professionals, 3) You do not share information with co-workers, professionals,

the client’s family, law enforcement, legislators, the Governor, or the client’s family, law enforcement, legislators, the Governor, or your friends or family without an authorization.your friends or family without an authorization.

The General Rule:The General Rule:No acknowledgement or disclosure of any confidential No acknowledgement or disclosure of any confidential information to anyone, without authorization.information to anyone, without authorization.

General Rule -------------General Rule -------------

Here is one way to reply to any formal or informal Here is one way to reply to any formal or informal request for information that is not covered by an request for information that is not covered by an authorization to release information. authorization to release information.

"I’m sorry, I can’t give you any information about "I’m sorry, I can’t give you any information about anyone without an authorization from the person"anyone without an authorization from the person"

The General Rule:The General Rule:No acknowledgement or disclosure of any No acknowledgement or disclosure of any confidential information to anyone, without confidential information to anyone, without authorization.authorization.


It is important to use this response consistently. Saying "I’m sorry, It is important to use this response consistently. Saying "I’m sorry, I can’t give you any information about anyone without an I can’t give you any information about anyone without an authorization from the person" when he/she is a client and saying authorization from the person" when he/she is a client and saying "No, X is not a client" when he/she is not a client will let anyone "No, X is not a client" when he/she is not a client will let anyone figure out fairly quickly that when you refuse to acknowledge figure out fairly quickly that when you refuse to acknowledge individuals without getting an authorization, they must be known to individuals without getting an authorization, they must be known to the department.the department.

Requests for information from media, legislators, family members, Requests for information from media, legislators, family members, or the Governor’s office all get the same response. Explain that or the Governor’s office all get the same response. Explain that confidentiality is governed by state and federal law. If the confidentiality is governed by state and federal law. If the questioner persists, you may refer them to your consultant or the questioner persists, you may refer them to your consultant or the Director of Youth Quest. Director of Youth Quest.

The General Rule:The General Rule:No acknowledgement or disclosure of any confidential No acknowledgement or disclosure of any confidential information to anyone, without authorization.information to anyone, without authorization.


1) Confidentiality still applies after a person’s death. 1) Confidentiality still applies after a person’s death. 2) You are bound by confidentiality after you leave the 2) You are bound by confidentiality after you leave the

position in which you acquired confidential information. position in which you acquired confidential information. 3) Information received from ANY source (client, 3) Information received from ANY source (client,

family/guardian, friends, neighbors, etc.) regarding family/guardian, friends, neighbors, etc.) regarding ANY person receiving services is confidential. ANY person receiving services is confidential.

Example: a client’s family member sees you in the Example: a client’s family member sees you in the grocery store and tells you something. You still treat it grocery store and tells you something. You still treat it as confidential, even if other people were present and as confidential, even if other people were present and could hear the conversation. could hear the conversation.


Even public information (e.g., available in Even public information (e.g., available in newspapers, phone books, vital records) which newspapers, phone books, vital records) which you learn in your work may be confidential you learn in your work may be confidential because your knowledge of a person or events because your knowledge of a person or events might imply a professional connection to the might imply a professional connection to the person. This could identify the person as person. This could identify the person as receiving services.receiving services.

This applies to such things as name, address, This applies to such things as name, address, and phone number even though these often and phone number even though these often can be found in the phone book! can be found in the phone book!

General Rule ExceptionsGeneral Rule Exceptions

There are specific exceptions in law which allow There are specific exceptions in law which allow disclosure of confidential information:disclosure of confidential information:

1) The major exception allows for use and disclosure if 1) The major exception allows for use and disclosure if the person or their legal guardian has given informed the person or their legal guardian has given informed approval and signed a written authorization for the approval and signed a written authorization for the release of information.release of information.

2) Some exceptions allow disclosure without a signed 2) Some exceptions allow disclosure without a signed authorization from the person, but it is always best to authorization from the person, but it is always best to obtain permission for a disclosure, if possible.obtain permission for a disclosure, if possible.

A person cannot be required to sign an authorization of A person cannot be required to sign an authorization of disclosure in order to apply for or receive services. disclosure in order to apply for or receive services.

HIPAA - A Note to the future HIPAA - A Note to the future

It is important to note that, under the It is important to note that, under the federal Health Insurance Portability and federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), there Accountability Act of 1996 (HIPAA), there may be further changes to this policy. may be further changes to this policy. You will be notified as they occur. You will be notified as they occur.

Exercise #1 ------------- Exercise #1 ------------- What should you say?What should you say?

1. You have just been called by a newspaper reporter who is asking for information 1. You have just been called by a newspaper reporter who is asking for information about a youth being served in your home. What is the correct response to about a youth being served in your home. What is the correct response to requests for information from the media?requests for information from the media?

A.A. I can only verify that the person is a client.I can only verify that the person is a client.B.B. I can’t give you any information about anyone without an authorization from the I can’t give you any information about anyone without an authorization from the

person.person.C.C. Yes I know the person, but I'm not at liberty to say anything else.Yes I know the person, but I'm not at liberty to say anything else.

2. An client's uncle stops you in the grocery store and wants information about his 2. An client's uncle stops you in the grocery store and wants information about his nephew. What is the correct response to requests for information from family nephew. What is the correct response to requests for information from family members?members?

A.A. I can't discuss this publicly, please call me at the office.I can't discuss this publicly, please call me at the office.B.B. I’m sorry, I can’t give you any information about anyone without an authorization from I’m sorry, I can’t give you any information about anyone without an authorization from

the person.the person.C.C. I'm not supposed to say anything, but maybe I can help you. What do you want to I'm not supposed to say anything, but maybe I can help you. What do you want to

know?know?

AnswersAnswers

1. B. is the correct answer. I can’t give 1. B. is the correct answer. I can’t give you any information about anyone you any information about anyone without an authorization from the person.without an authorization from the person.

2. Again B. is the right answer. It does 2. Again B. is the right answer. It does not matter if it is a family member.not matter if it is a family member.


Good for you! Good for you! You have completed the Confidentiality section of You have completed the Confidentiality section of training.training.

Hopefully you have learned the basics about the Youth Hopefully you have learned the basics about the Youth Quest Quest confidentiality policy. confidentiality policy.

More specifically you covered and learned to:More specifically you covered and learned to: Define the general rule. Define the general rule. Give the correct response to inquires. Give the correct response to inquires. Describe what is confidential. Describe what is confidential. If you feel that you have learned the training material presented in If you feel that you have learned the training material presented in

this section please move on to Section 2 - Informed Consent.this section please move on to Section 2 - Informed Consent. Remember you can request review during in-service of any pre-Remember you can request review during in-service of any pre-

service training material as often as needed. The goal of the service training material as often as needed. The goal of the training is not speed but comprehension. training is not speed but comprehension.

Section 2 – Section 2 – Informed ConsentInformed Consent

Great, you have made it to Section #2!Great, you have made it to Section #2!Informed Consent. Now you will focus on how Informed Consent. Now you will focus on how

to get consumer consent that will allow the to get consumer consent that will allow the release of confidential information.release of confidential information.

In this section you will learn to:In this section you will learn to: Define the concept of informed consent. Define the concept of informed consent. Outline what the consumer must understand, at Outline what the consumer must understand, at

a minimum, for consent. a minimum, for consent. Learn about Consent, Authorization, and the Learn about Consent, Authorization, and the

Notice of Privacy Practices. Notice of Privacy Practices.

Informed ConsentInformed Consent

Clients must be informed about privacy Clients must be informed about privacy practices and the laws, rights, and regulations practices and the laws, rights, and regulations that protect their health information.that protect their health information.

They must be provided a summary of these They must be provided a summary of these practices.practices.

Here is the Youth Quest Notice of Privacy Here is the Youth Quest Notice of Privacy Practices Practices

Informed Consent -------- Informed Consent --------

The concept of "Informed Consent" is applicable to The concept of "Informed Consent" is applicable to authorizing disclosure of confidential information.authorizing disclosure of confidential information.

Informed consent is freely given and based on an Informed consent is freely given and based on an explanation and understanding of what is to be explanation and understanding of what is to be disclosed, to whom, for what purpose, the potential disclosed, to whom, for what purpose, the potential risks and benefits of disclosure or non-disclosure, risks and benefits of disclosure or non-disclosure, alternatives to disclosure, and the right to refuse or alternatives to disclosure, and the right to refuse or revoke consent.revoke consent.

There are two different forms for which people are There are two different forms for which people are asked to give their informed approval. One is to give asked to give their informed approval. One is to give consent to Youth Quest to disclose information for consent to Youth Quest to disclose information for treatment, payment and healthcare operations. treatment, payment and healthcare operations.

Notice Of Privacy PracticesNotice Of Privacy Practices

Important! This notice describes how medical and personal information about Important! This notice describes how medical and personal information about you may be used and shared with other agencies and persons and how you you may be used and shared with other agencies and persons and how you get access to certain information. Please review it carefully!get access to certain information. Please review it carefully!

This notice is effective on January 1, This notice is effective on January 1, 20072007

Youth Quest Inc. collects and shares information about you in order to provide the Youth Quest Inc. collects and shares information about you in order to provide the highest quality services. All information we know about you is private and highest quality services. All information we know about you is private and “confidential”. This information is protected by Federal and State laws.“confidential”. This information is protected by Federal and State laws.

This Notice of Privacy Practices for Youth Quest Inc. tells you how we will use and This Notice of Privacy Practices for Youth Quest Inc. tells you how we will use and share the information about you. At all times, only the minimum amount of share the information about you. At all times, only the minimum amount of information needed will be released. This notice does not describe all precise information needed will be released. This notice does not describe all precise circumstances, but is an overview. Youth Quest Inc. is required to notify you of our circumstances, but is an overview. Youth Quest Inc. is required to notify you of our privacy practices and to follow the terms of this privacy practice notice. We privacy practices and to follow the terms of this privacy practice notice. We reserve the right to revise this notice as necessary.reserve the right to revise this notice as necessary.

For further information regarding Youth Quest Privacy practices, please contact the For further information regarding Youth Quest Privacy practices, please contact the Youth Quest Clinical Director; (919) 942-1625. This notice is posted on our Youth Quest Clinical Director; (919) 942-1625. This notice is posted on our website: website: www.youthquestinc.orgwww.youthquestinc.org

CONTINUED……CONTINUED……

Youth Quest Inc. May Use and Share Information Youth Quest Inc. May Use and Share Information

Without Your Authorization!Without Your Authorization! In Order to Treat YouIn Order to Treat You- We will release information when necessary to coordinate your care and treatment. This means - We will release information when necessary to coordinate your care and treatment. This means

that we will share information about you with other mental health providers and they will share information with us in that we will share information about you with other mental health providers and they will share information with us in order to help you and to create and fulfill your treatment plan. This could include the referral to a different facility or order to help you and to create and fulfill your treatment plan. This could include the referral to a different facility or agency.agency.

In Order to Gain Reimbursement Payments for ServiceIn Order to Gain Reimbursement Payments for Service-We may release confidential information in order to gain -We may release confidential information in order to gain payment for services we render to you. This information is used to determining eligibility, managing claims, payment for services we render to you. This information is used to determining eligibility, managing claims, determining the needs for services, certifying services, review of services, administrative actions related to this, etc.determining the needs for services, certifying services, review of services, administrative actions related to this, etc.

In Order to Provide Better ServiceIn Order to Provide Better Service- We may release confidential information to the Mental Health agencies we work with - We may release confidential information to the Mental Health agencies we work with in order to improve the quality of services, improve consumer satisfaction, resolve concerns, and evaluate in order to improve the quality of services, improve consumer satisfaction, resolve concerns, and evaluate performance of agencies. We will also release information if needed to inspect or investigate an agencyperformance of agencies. We will also release information if needed to inspect or investigate an agency

In Order to determine EligibilityIn Order to determine Eligibility- We may share information about you in order to determine if you are eligible for certain - We may share information about you in order to determine if you are eligible for certain programs that could be helpful to your treatment including private or government agencies (example SSI or others).programs that could be helpful to your treatment including private or government agencies (example SSI or others).

In Order to Ensure SafetyIn Order to Ensure Safety- We will share information with others in order to protect you or others from harm or to try and - We will share information with others in order to protect you or others from harm or to try and prevent a crime from occurring if it appears it may.prevent a crime from occurring if it appears it may.

In Order to Treat You in an EmergencyIn Order to Treat You in an Emergency- We will share information in emergency situations such as a medical - We will share information in emergency situations such as a medical emergency or other mental health emergency.emergency or other mental health emergency.

In Order To Follow the Law for Certain SituationsIn Order To Follow the Law for Certain Situations- We will share information with Public Health Agencies if we suspect - We will share information with Public Health Agencies if we suspect you may have a communicable disease. We will share information to Law enforcement when required by law or you may have a communicable disease. We will share information to Law enforcement when required by law or court order. court order.

In Order to Report suspected Abuse, Neglect, or ExploitationIn Order to Report suspected Abuse, Neglect, or Exploitation- We will share information with government agencies - We will share information with government agencies designated to investigate if there is a suspicion of abuse, neglect, or exploitation.designated to investigate if there is a suspicion of abuse, neglect, or exploitation.

In Order to Keep the Team Informed About Your ProgressIn Order to Keep the Team Informed About Your Progress- We will share information about you with a relative, close - We will share information about you with a relative, close personal friend, or other person involved in your care if the information is relevant to your care. If you are a minor, personal friend, or other person involved in your care if the information is relevant to your care. If you are a minor, we will share information about you and your treatment to your parent, guardian, or other responsible person except we will share information about you and your treatment to your parent, guardian, or other responsible person except in certain circumstances protected by law. in certain circumstances protected by law.

Other Information Will Only Be Released with your Written AuthorizationOther Information Will Only Be Released with your Written Authorization In other circumstances not listed above In other circumstances not listed above when information could be shared with others, we will only release the information after you have signed the when information could be shared with others, we will only release the information after you have signed the “Authorization for the Release of Personal and Health Information”. You have the right to revoke that consent.“Authorization for the Release of Personal and Health Information”. You have the right to revoke that consent.

You Have Certain Rights You Have Certain Rights Related to Your PrivacyRelated to Your Privacy

You Have The RightYou Have The Right- To question the accuracy or completeness of the information in your - To question the accuracy or completeness of the information in your record. If something is incorrect you may request us to change it to reflect accuracy. You will record. If something is incorrect you may request us to change it to reflect accuracy. You will need to request in writing what you disagree with and why. A decision will be made about the need to request in writing what you disagree with and why. A decision will be made about the accuracy of the record and the need for change by the Clinical Director.accuracy of the record and the need for change by the Clinical Director.

You Have The RightYou Have The Right- To see and get copies of your records in many cases when it is - To see and get copies of your records in many cases when it is determined to be in your best interest to receive those records. You should request the copies determined to be in your best interest to receive those records. You should request the copies in writing and you may be charged a reasonable fee for copies.in writing and you may be charged a reasonable fee for copies.

You Have The RightYou Have The Right- To be contacted in a manner that is the most convenient for you. We - To be contacted in a manner that is the most convenient for you. We will agree to any reasonable request to change the manner in which you are typically will agree to any reasonable request to change the manner in which you are typically contacted to insure a strong communication between team members. contacted to insure a strong communication between team members.

You Have the Right- You Have the Right- ToTo You have the right to request that we limit the use and disclosure of You have the right to request that we limit the use and disclosure of medical information about you for treatment, payment and health care operations. We are medical information about you for treatment, payment and health care operations. We are notnot required to agree to your request. If we do agree to your request, we must follow your required to agree to your request. If we do agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time.the restrictions at any time.

You Have The RightYou Have The Right- Under certain circumstances, to request a list of agencies to which - Under certain circumstances, to request a list of agencies to which confidential disclosures have been made that were not done to improve treatment, service, confidential disclosures have been made that were not done to improve treatment, service, communication, or determine government eligibility. This would not include information communication, or determine government eligibility. This would not include information provided to your team members and your family members and information given with your provided to your team members and your family members and information given with your signed consent.signed consent.

You Have The RightYou Have The Right- To receive updated versions of this Notice Of Privacy Practices and - To receive updated versions of this Notice Of Privacy Practices and Youth Quest Inc. will make every reasonable effort to insure you have the most recent version Youth Quest Inc. will make every reasonable effort to insure you have the most recent version available.available.

You Have The Right to File a Complaint You Have The Right to File a Complaint regarding Youth Quest Inc’s Privacy Practices.regarding Youth Quest Inc’s Privacy Practices.

If you feel that your rights to privacy have been violated or are not satisfied with the procedures of If you feel that your rights to privacy have been violated or are not satisfied with the procedures of Youth Quest Inc., you may file a complaint with us about this concern. We will not take adverse Youth Quest Inc., you may file a complaint with us about this concern. We will not take adverse action against you if you file a complaint but will rather work to the best of our ability to resolve the action against you if you file a complaint but will rather work to the best of our ability to resolve the concern.concern.

To file a formal complaint with Youth Quest Inc., please contact one of the Family Teachers or other To file a formal complaint with Youth Quest Inc., please contact one of the Family Teachers or other clinical supervisors and request a copy of the Grievance form. clinical supervisors and request a copy of the Grievance form.

Please fill out and submit the grievance form as quickly as possible so that we as a team can work to Please fill out and submit the grievance form as quickly as possible so that we as a team can work to resolve the concern.resolve the concern.

You may also contact the Governor’s Advocacy Council for Persons with Disabilities at You may also contact the Governor’s Advocacy Council for Persons with Disabilities at www.gacpd.comwww.gacpd.com on the internet or at 1-800-821-6922. Their Fax Number is 1-919-733-9173.Their on the internet or at 1-800-821-6922. Their Fax Number is 1-919-733-9173.Their address is:address is: ]]

GACPDGACPD1314 Mail Service Center1314 Mail Service CenterRaleigh, NC 27699-1314 Raleigh, NC 27699-1314

Additionally, you may contact the: Additionally, you may contact the: Office for Civil RightsOffice for Civil RightsUS Department of Health and Human ServicesUS Department of Health and Human Services 61 Forsyth 61 Forsyth

Street, SW. – Suite 3B70Street, SW. – Suite 3B70Atlanta, GA 30323Atlanta, GA 30323(404) 562-7886; (404) 562-7881 Fax (404) 562-7886; (404) 562-7881 Fax

Signature obtainedSignature obtained

I understand and have received a copy of this I understand and have received a copy of this Notice Of Privacy Practices for Youth Quest Notice Of Privacy Practices for Youth Quest Inc. Signed Inc. Signed __________________________________________________________________________Date: ________________Date: ________________

Signature of client/legally responsible personSignature of client/legally responsible person

Witnessed: Witnessed: __________________________________________________________________________Date: ________________Date: ________________


The person or guardian must be informed The person or guardian must be informed of the privacy practices of Youth Quest, of the privacy practices of Youth Quest, the laws and rules protecting the laws and rules protecting confidentialityconfidentiality of health information, and of health information, and the exceptions which allow disclosure the exceptions which allow disclosure without the person’s approval. without the person’s approval.

This Information has been presented as This Information has been presented as simply as possiblesimply as possible


This is what the consumer must understand, at a This is what the consumer must understand, at a minimum, in order to give informed approval for the use minimum, in order to give informed approval for the use or disclosure of health information. or disclosure of health information.

1) PURPOSE 1) PURPOSE 2) TO WHOM OR FROM WHOM INFORMATION IS 2) TO WHOM OR FROM WHOM INFORMATION IS

BEING SENTBEING SENT3) TIME LIMIT3) TIME LIMIT4) RISKS & BENEFITS4) RISKS & BENEFITS5) ALTERNATIVES 5) ALTERNATIVES 6) CONSEQUENCES 6) CONSEQUENCES 7) REVOCATION 7) REVOCATION

Authorization For Release of Authorization For Release of InformationInformation

The other form which requires informed The other form which requires informed approval is the Authorization to Release approval is the Authorization to Release Information which allows Youth Quest to Information which allows Youth Quest to obtain specific information from or release obtain specific information from or release specific information to other entities. specific information to other entities.

AUTHORIZATION TO RELEASE INFORMATIONAUTHORIZATION TO RELEASE INFORMATION

Informed ConsentInformed Consent Exercise #2Exercise #2

Check Your Knowledge Check Your Knowledge 1. What concept is applicable to authorizing disclosure of confidential information?1. What concept is applicable to authorizing disclosure of confidential information?

A. Explained ConsentA. Explained ConsentB. Informed ApprovalB. Informed ApprovalC. Consent DecreeC. Consent Decree

2. Information should be provided. . .2. Information should be provided. . .

A. in writing.A. in writing.B. verbally.B. verbally.C. in whatever form the person understands best.C. in whatever form the person understands best.

3. On the release of the Authorization for Release of Information form, which of these does not 3. On the release of the Authorization for Release of Information form, which of these does not need to be specifically authorized?need to be specifically authorized?

A. Heart ConditionA. Heart ConditionB. HIV/AidsB. HIV/AidsC. Substance AbuseC. Substance Abuse

4. Which of the following are the minimal requirements for informed approval?4. Which of the following are the minimal requirements for informed approval?

A. Purpose, Time Limit, Risks & Benefits, Alternatives, Consequences, and Revocation.A. Purpose, Time Limit, Risks & Benefits, Alternatives, Consequences, and Revocation.B. Purpose, Time Limit, Laws, Alternatives, Billing Services, and Revocation.B. Purpose, Time Limit, Laws, Alternatives, Billing Services, and Revocation.C. Purpose, Process, Risks & Benefits, Alternatives, Consequences, and Renewal.C. Purpose, Process, Risks & Benefits, Alternatives, Consequences, and Renewal.

Answers:Answers:

1. B. Informed Approval1. B. Informed Approval

2. C. in whatever form the person understands 2. C. in whatever form the person understands best.best.

3. A. Heart Condition would be included in 3. A. Heart Condition would be included in general health information and does not general health information and does not require a specific authorization within the formrequire a specific authorization within the form

4. A. Purpose, Time Limit, Risks & Benefits, 4. A. Purpose, Time Limit, Risks & Benefits, Alternatives, Consequences, and Revocation.Alternatives, Consequences, and Revocation.

Informed Consent Informed Consent

Terrific! Terrific! You have already completed two sections.You have already completed two sections.In this section you learned to:In this section you learned to: Define the concept of informed consent. Define the concept of informed consent. Outline what the consumer at minimum must Outline what the consumer at minimum must

understand for consent. understand for consent. You may want to revisit this section if you have You may want to revisit this section if you have

questions about the consent or authorization process. questions about the consent or authorization process. Remember that these training materials are here for Remember that these training materials are here for your reference any time you need them.your reference any time you need them.

Exceptions --------Exceptions --------

You are flying now! You are flying now!

The General Rule and Informed Consent The General Rule and Informed Consent sections are done and you can focus on sections are done and you can focus on your next section, the Exceptions section.your next section, the Exceptions section.

In this section you will learn to: In this section you will learn to: Identify the 12 categories of exceptions. Identify the 12 categories of exceptions.

We’ve reviewed the informed consent and signed We’ve reviewed the informed consent and signed authorization process.authorization process.

There are exceptions which allow for disclosure There are exceptions which allow for disclosure without the person’s specific approval. The without the person’s specific approval. The person must be informed of these exceptions person must be informed of these exceptions when confidentiality is explained. The person when confidentiality is explained. The person should also be informed of disclosures made should also be informed of disclosures made without their approval whenever possible.without their approval whenever possible.

Best practice is to have a signed authorization Best practice is to have a signed authorization whenever possible.whenever possible.

ExceptionsExceptions

There are 10 categories of Possible Exceptions. There are 10 categories of Possible Exceptions. 1) EMERGENCY1) EMERGENCY includes any situation where there is clear includes any situation where there is clear

imminent threat or danger to a person. In an emergency or when imminent threat or danger to a person. In an emergency or when there is suspected abuse or neglect, necessary information may there is suspected abuse or neglect, necessary information may be released without the person's consent. This is limited only to be released without the person's consent. This is limited only to that information necessary to accomplish the purpose of that information necessary to accomplish the purpose of disclosure. Examples of emergencies include:disclosure. Examples of emergencies include:- Suicidal or other danger to self.- Suicidal or other danger to self.- Health/medical emergency.- Health/medical emergency.- Responsibility to warn others of specific threatened harm - Responsibility to warn others of specific threatened harm

2) INVOLUNTARY ADMISSION2) INVOLUNTARY ADMISSION requires sufficient information to requires sufficient information to justify admission.justify admission.

ExceptionsExceptions

3) MANDATORY REPORTING3) MANDATORY REPORTING of abuse/neglect supercedes confidentiality. This of abuse/neglect supercedes confidentiality. This applies whether the person is a victim or perpetrator. Substance abuse programs applies whether the person is a victim or perpetrator. Substance abuse programs can make an initial report of the abuse without an authorization, but any further can make an initial report of the abuse without an authorization, but any further information will require a specific authorization.information will require a specific authorization.

4) FOR PURPOSES OF REIMBURSEMENT4) FOR PURPOSES OF REIMBURSEMENT – Youth Quest may release information – Youth Quest may release information without a signed authorization for payment purposes such as billing Medicaid, or without a signed authorization for payment purposes such as billing Medicaid, or other insurers .other insurers .

5) SPOUSE OR NEXT OF KIN5) SPOUSE OR NEXT OF KIN may be given general information about a person’s may be given general information about a person’s physical condition or mental status (for example, "John's condition is stable".) physical condition or mental status (for example, "John's condition is stable".) unless the person has restricted disclosure of this information. unless the person has restricted disclosure of this information.

6) COURT ORDER:6) COURT ORDER: Refer to the "Court Proceedings" section of the Guidelines. A Refer to the "Court Proceedings" section of the Guidelines. A subpoena issued by an attorney or administrative agency is not a court order.subpoena issued by an attorney or administrative agency is not a court order.

7) WITHIN A LOCAL MANAGEMENT ENTITY (LME):7) WITHIN A LOCAL MANAGEMENT ENTITY (LME): The LME exception applies to The LME exception applies to sharing of information among members of an individual’s treatment team. It does sharing of information among members of an individual’s treatment team. It does not allow wholesale sharing of information between agencies. not allow wholesale sharing of information between agencies.

Federal Mental Health & Substance Abuse law allows for "Qualified Service Federal Mental Health & Substance Abuse law allows for "Qualified Service Agreements" among programs.Agreements" among programs.

Exceptions….Exceptions….

8) INTERNAL OPERATIONS:8) INTERNAL OPERATIONS: In addition to payment, Youth Quest In addition to payment, Youth Quest may also share information internally as needed for treatment and may also share information internally as needed for treatment and health care operations, including planning and administrative health care operations, including planning and administrative purposes. Still, information should always be limited to a legitimate purposes. Still, information should always be limited to a legitimate "need to know" and the minimum necessary. "need to know" and the minimum necessary.

9) AS OTHERWISE REQUIRED BY LAW:9) AS OTHERWISE REQUIRED BY LAW: This includes reporting This includes reporting criminal activity or reporting certain diseases to public health criminal activity or reporting certain diseases to public health officials. officials.

10) RESEARCH10) RESEARCH must be approved by an Institutional Review Board must be approved by an Institutional Review Board and requires informed consent for participation. No identifiable and requires informed consent for participation. No identifiable information is allowed in research reports. Researchers are information is allowed in research reports. Researchers are required to sign "Non-Employee Understanding of Confidentiality" required to sign "Non-Employee Understanding of Confidentiality" form.form.


Exercise #3 Give it a Try!Exercise #3 Give it a Try!1. In an emergency situation, necessary information may be released without 1. In an emergency situation, necessary information may be released without

consent.consent.TRUETRUE

2. Specific threatened harm to others would be considered an emergency.2. Specific threatened harm to others would be considered an emergency.TRUETRUE

3. Involuntary Admission allows for confidential information to be disclosed.3. Involuntary Admission allows for confidential information to be disclosed. TRUETRUE4. Youth Quest may release information for payment purposes to insurers.4. Youth Quest may release information for payment purposes to insurers. TRUE TRUE 5. A person may restrict disclosures so that their spouse or next of kin cannot 5. A person may restrict disclosures so that their spouse or next of kin cannot

be given any information.be given any information. TRUETRUE6. Information may not be shared with members of an individual's LSN 6. Information may not be shared with members of an individual's LSN

treatment team.treatment team.FALSEFALSE


Way to Go! Way to Go! There was a lot of content in the There was a lot of content in the pages of this section. pages of this section.

This Exceptions section is very important This Exceptions section is very important because it defines the times when you do not because it defines the times when you do not need to get approval for the release of need to get approval for the release of confidential information. Hopefully, you have confidential information. Hopefully, you have learned to:learned to:

Identify the 10 categories of exceptions. Identify the 10 categories of exceptions. You can now move on to the last content section You can now move on to the last content section

on security.on security.

Security ----------Security ----------

If you are keeping track, you know that the Security If you are keeping track, you know that the Security section is the last one that covers new content. section is the last one that covers new content. Although you are almost done, pay particular notice to Although you are almost done, pay particular notice to this section. It reviews policies that impact your this section. It reviews policies that impact your everyday work.everyday work.

In this section you will learn to: In this section you will learn to: Describe the "Need to Know" concept. Describe the "Need to Know" concept. Comply with the password policy. Comply with the password policy. Use proper e-mail, fax, cell phone and computer Use proper e-mail, fax, cell phone and computer

safeguards. safeguards. Secure data in the office environment. Secure data in the office environment.

SecuritySecurity

The foremost idea in data security is the "The foremost idea in data security is the "Need To Need To KnowKnow" concept." concept.

Need To Know is Youth Quest’s rule used to decide Need To Know is Youth Quest’s rule used to decide what kind of access to certain health information what kind of access to certain health information an employee needs in order to do his or her job.an employee needs in order to do his or her job.

The "Need To Know" concept is based on the The "Need To Know" concept is based on the professional work requirements so that access to professional work requirements so that access to confidential information is limited to that needed for confidential information is limited to that needed for employees to perform their job functions. For example, employees to perform their job functions. For example, a person who provides transportation for a client does a person who provides transportation for a client does not need to know the client's medical history when it not need to know the client's medical history when it does not affect the transportation.does not affect the transportation.

SecuritySecurity

A word about passwords.A word about passwords. When you go to your work station and crank up your When you go to your work station and crank up your

computer using your password you are using security computer using your password you are using security that is based on "need to know". that is based on "need to know".

NEVERNEVER share your passwords with anyone else. share your passwords with anyone else. Change your password frequently and do not use a Change your password frequently and do not use a family name or other easy to figure out password to family name or other easy to figure out password to ensure no one knows your passwords.ensure no one knows your passwords.

Because Youth Quest requires that you have access Because Youth Quest requires that you have access only to the information you need to do your job.only to the information you need to do your job.

SecuritySecurity

While away from the computer, remember the old While away from the computer, remember the old World War II saying that loose lips sink ships. Never World War II saying that loose lips sink ships. Never discuss confidential information in places where you discuss confidential information in places where you could be overheard by co-workers or visitors who are could be overheard by co-workers or visitors who are not authorized to have the information.not authorized to have the information.

If you are using cell phones, 2-way radios, e-mail, If you are using cell phones, 2-way radios, e-mail, faxes, answering machines, and other electronic forms faxes, answering machines, and other electronic forms of communication, do not send confidential information of communication, do not send confidential information except when there are safeguards in place to prevent except when there are safeguards in place to prevent unauthorized access.unauthorized access.

Next you will review some of specific policies in Next you will review some of specific policies in transmitting confidential data. transmitting confidential data.

SecuritySecurity

Fax numbers Fax numbers should be verified before a fax is sent, and the person who is receiving the information must be should be verified before a fax is sent, and the person who is receiving the information must be aware that the information is being sent. Cover sheets on the faxes shall identify the enclosed information as aware that the information is being sent. Cover sheets on the faxes shall identify the enclosed information as confidential and provide clear direction to limit who can receive the information. confidential and provide clear direction to limit who can receive the information.

E-mailE-mail containing protected health information (PHI) can only be sent as follows: containing protected health information (PHI) can only be sent as follows: A. Email transmissions shall not contain PHI in the body of the message text or in the subject line. A. Email transmissions shall not contain PHI in the body of the message text or in the subject line. B. Any PHI contained in an email must be in the form of a password protected attachment as described below. B. Any PHI contained in an email must be in the form of a password protected attachment as described below. C. Passwords shall not be communicated over any email transmission. When sharing your password with your C. Passwords shall not be communicated over any email transmission. When sharing your password with your

intended recipient, communicate the password for the protected file over the telephone or fax machine. intended recipient, communicate the password for the protected file over the telephone or fax machine. D. Shared passwords should be modified on a periodic basis with the goal of preventing unauthorized access. D. Shared passwords should be modified on a periodic basis with the goal of preventing unauthorized access. E. Listing of all passwords must be securely protected at all times. At no time shall a printed version of passwords E. Listing of all passwords must be securely protected at all times. At no time shall a printed version of passwords

be visible to any passer-by. Supervisors shall have copies of passwords for all protected files. be visible to any passer-by. Supervisors shall have copies of passwords for all protected files. F. Printed material containing PHI must be sent to a printer within an individual’s workgroup or other location where F. Printed material containing PHI must be sent to a printer within an individual’s workgroup or other location where

the individual printing the PHI can readily access the material once it is printed. Printers must be located in the individual printing the PHI can readily access the material once it is printed. Printers must be located in non-public areas or offices that require security keys, badges, or similar mechanisms in order to limit access. non-public areas or offices that require security keys, badges, or similar mechanisms in order to limit access. Users and/or their supervisors shall have the administrative privileges of terminating a print job once in the Users and/or their supervisors shall have the administrative privileges of terminating a print job once in the network queue. If printing problems are encountered, user shall delete the print job to prevent unauthorized network queue. If printing problems are encountered, user shall delete the print job to prevent unauthorized disclosure of PHI. disclosure of PHI.

Analog cell phone and two-way radio signals may be picked up by other receivers and must not be used to convey Analog cell phone and two-way radio signals may be picked up by other receivers and must not be used to convey confidential information. confidential information.

Answering machines whose access is not limited to only the individual receiving the message shall not be used to Answering machines whose access is not limited to only the individual receiving the message shall not be used to convey confidential information." convey confidential information."

SecuritySecurity

Back to computers.Back to computers. Remember that you can not leave your computer Remember that you can not leave your computer

unattended when you have confidential information unattended when you have confidential information open. Yes, that means those 5 minute breaks do not open. Yes, that means those 5 minute breaks do not start until you close access to the files containing the start until you close access to the files containing the confidential material. Treat an unattended computer as confidential material. Treat an unattended computer as not just a possible window to your files but a open not just a possible window to your files but a open security threat to all the Department's files.security threat to all the Department's files.

To further deter wandering eyes, always try to keep To further deter wandering eyes, always try to keep your computer screens turned away from doorways or your computer screens turned away from doorways or areas where unauthorized viewing could occur.areas where unauthorized viewing could occur.

SecuritySecurity

Computer discs, paper records, or any form of Computer discs, paper records, or any form of stored information must not be left out on stored information must not be left out on desks or in unsecured locations. That means desks or in unsecured locations. That means those accidental copies left in the copying those accidental copies left in the copying machine or those files you printed out and left machine or those files you printed out and left at the printer for an hour are security breaches. at the printer for an hour are security breaches. Ouch! Ouch!

When records are not in use, they must be When records are not in use, they must be stored in a locked file cabinet or similar secure stored in a locked file cabinet or similar secure location.location.

SecuritySecurity

A few final thoughts on data securityA few final thoughts on data security

Original records are not to be removed from a Youth Original records are not to be removed from a Youth Quest site unless needed for the compliance of a court Quest site unless needed for the compliance of a court order, and then only when a certified copy is not order, and then only when a certified copy is not acceptable. If the original record is removed, a acceptable. If the original record is removed, a complete certified copy of the entire record must be complete certified copy of the entire record must be retained.retained.

When anyone, other than staff, review records, they When anyone, other than staff, review records, they must be supervised to assure that no documents are must be supervised to assure that no documents are removed from the record and no changes are made to removed from the record and no changes are made to it. This will allow Youth Quest to keep a complete copy it. This will allow Youth Quest to keep a complete copy of the client’s master file.of the client’s master file.

Security QuizSecurity Quiz

1. Need To Know is the Youth Quest’s rule used to. . .1. Need To Know is the Youth Quest’s rule used to. . .A. determine consumer eligibility for specific programs.A. determine consumer eligibility for specific programs.B. assess an employee understanding of Youth Quest’s educational requirements.B. assess an employee understanding of Youth Quest’s educational requirements.C. decide what kind of access to certain health information an employee needs in order to do his or her job.C. decide what kind of access to certain health information an employee needs in order to do his or her job.

2. You share your password. . .2. You share your password. . .A. When going on vacation.A. When going on vacation.B. Never.B. Never.C. When a coworker asks.C. When a coworker asks.

3. Which of the following is not an appropriate location for discussing confidential information?3. Which of the following is not an appropriate location for discussing confidential information?A. In the reception area.A. In the reception area.B. In your supervisor's office.B. In your supervisor's office.C. On the phone in your office.C. On the phone in your office.

4. When you take a bathroom break, you should. . .4. When you take a bathroom break, you should. . .A. do nothing just go.A. do nothing just go.B. make sure both computer and paper files are secure.B. make sure both computer and paper files are secure.C. shut off your computer.C. shut off your computer.

5. When printing information about consumers you should retrieve the information. . .5. When printing information about consumers you should retrieve the information. . .A. hourly.A. hourly.B. immediately.B. immediately.C. at the end of the day.C. at the end of the day.

Answers:Answers:

1. C. decide what kind of access to 1. C. decide what kind of access to certain health information an employee certain health information an employee needs in order to do his or her job.needs in order to do his or her job.

2. B. Never.2. B. Never. 3. A. In the reception area.3. A. In the reception area. 4. B. Make sure both computer and 4. B. Make sure both computer and

paper files are secure.paper files are secure. 5. B. immediately.5. B. immediately.

Security ----------Security ----------

Good Work!Good Work! Remember that you have been given access to confidential Remember that you have been given access to confidential

information based on the need to know. You are also responsible information based on the need to know. You are also responsible to maintain the integrity of the need to know concept when you are to maintain the integrity of the need to know concept when you are using the data.using the data.

In this section you learned to:In this section you learned to: Describe the "Need to Know" concept Describe the "Need to Know" concept Comply with the password policy. Comply with the password policy. Use proper e-mail, fax, cell phone and computer safeguards. Use proper e-mail, fax, cell phone and computer safeguards. Secure data in the office environment. Secure data in the office environment. If you feel comfortable with the material in this section move on to If you feel comfortable with the material in this section move on to

the case example!the case example!

Basic ConfidentialityBasic Confidentiality

Congratulations!Congratulations! You have completed the You have completed the basic confidentiality content areas of this basic confidentiality content areas of this training. (Provided you did not skip training. (Provided you did not skip directly to this point)directly to this point)

Pat yourself on the back and be sure to Pat yourself on the back and be sure to request case examples during in-services request case examples during in-services when possible.when possible.

Documents

Youth Quest