Confidentiality and its Limits

We've touched briefly upon this ASWB exam outline item before and offered this simple guidance:

Suggested reading (and rereading): NASW Code of Ethics sections 1.07, Privacy and Confidentiality, and 2.02 Confidentiality with Colleagues. Also, as a bonus, here's NASW's helpful HIPAA Highlights for Social Workers. 

Let's dig in a little further here. This is a ripe area for exam writers; expect to see privacy, confidentiality, and/or reporting questions on the social work licensing exam--more than once in a 170-question test. May as well be prepared!

In addition to the above reading, consider these confidentiality-themed columns from Eye on Ethics, Fredric Reamer's column at Social Work Today:

• The Limits of Confidentiality
• The Complexities of Client Privacy, Confidentiality, and Priviledged Communication
• Sharing Client Information with Colleagues: Ethical Challenges
• The Challenge of Facing Subpoenas--Protecting Client Confidentiality
• The Limits of Confidentiality & Revisiting the Limits of Client Confidentiality
• When to Break Client Confidentiality with Minors

Each column contains material for a bunch of different licensing exam questions. Take a moment to imagine that you're an exam writer charged with generating new exam material. What would you ask?

From the subpoena article, you might picture something like this:

A social worker receives a subpoena for client records. How should she respond?

Some possible answers:

Refuse to comply with the subpoena.

Comply with the records request.

Comply with the records request, withholding information about drug or alcohol use.

Comply partially with the records request.

Comply partially with the records request, per the client's wishes.

Consult with an attorney.

Consult with a supervisor.

Consult with the client.

Consult with a colleague who has recently been through the same situation.

On the real exam, you'll just face four answers, A-D. The best answer will depend upon the group. Here's Reamer on the basic ethical principles social workers ought to consider when facing this legal request:

To protect clients and adhere to the Code of Ethics, social workers should understand their obligation to challenge subpoenas in the absence of client consent or a court order. Usually with the benefit of legal consultation (which may include consulting the client's attorney, with the client's consent), social workers may object to the subpoena or file a motion to quash the subpoena. Depending on the circumstances, social workers may challenge the subpoena on the grounds that it requests confidential or privileged information that the social worker is not authorized to release (for example, because the client did not consent to disclosure or disclosure would violate relevant laws) or that the scope of information requested by the subpoena is overly broad and needs to be narrowed. The law recognizes the importance of protecting certain communications between professionals and clients and grants them a privileged status during legal proceedings. For example, both state and federal laws prevent certain professionals, such as social workers, from being forced to testify or submit documents about their clients (although there are some narrow exceptions).

Happy reading and preparing. Remember that you're not alone--practice tests are very helpful for this topic and many others.

Good luck on the exam. Congratulations in advance!