Within agency working I have found that the information shared is often different to the therapeutic concept of confidentiality. It is expected that when working within an agency that other colleagues know the identity of my clients. This would not happen within my private practice. Confidentiality is explained in child friendly language to the child or adolescent and it is also explained to the parents and care givers. As well as it being printed in my written contract I discuss this openly and in a matter of fact way during the initial session with the child or adolescent and parents or caring adults.
As previously discussed there can be ‘gaps’ in information where it is not documented where, or with whom children were, during some periods of their early life, if they were living within a transitory or not registered community. This can be difficult for children who wish to understand their past. Children themselves can often find that due to their physical and mental development they do not have memories of their early life.
This is ordinary, due to the hippocampus, which processes memory in order for it to be stored as explicit memory is not developed fully until the age of 3 or four years of age. Loving, caring parents can often fill these ‘gaps’ in the memory. When their primary care givers have been unable due to their own deficits to know what happened or where (having a coherent narrative)
They will be unable to explain to the child or adolescent what happened to them in their early years.
Personal data is information, which relates to an identifiable living individual that is processed as data. This would include names, dates of birth, addresses, medical information and reviews.
Sensitive personal information is information that relates to ethnicity and race, political beliefs, religious or faith beliefs, physical or mental health issues, sexuality and any criminal offences.
In holding both personal and sensitive personal data, I am aware that there are greater legal restrictions on the latter, as some of the personal information may be freely available, for example on line, or in a telephone book.
The way that I hold the information is protected by the data protection act that ensures that in holding such information I make certain steps to ensure this is kept safe and that reasonable steps are taken to ensure the information remains private. I see this about respecting other’s privacy and protecting that information that I have been privileged to be party to.
There are times when I will break confidentiality, this is when I believe there is a probability that either the client will hurt themselves, or others, or others property. In these scenarios I will usually discuss the situation and tell the client I am going to act upon the information they have told me. If a disclosure of a crime against children is made, an act of terrorism either planned or executed or money laundering then without prior consent I will not discuss this with the client, unless they are the victim, not the perpetrator of a crime against children and break confidentiality and inform the relevant authorities.
Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice or treatment to under 16-year-olds without parental consent Gillick was the family name of the 16 year old girl and mother at the centre of the case and Fraser refers to Lord Fraser who following the ruling, looked at the case in the House of Lords. After this, they have been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. When working with children and adolescents it is necessary again with the use of developmental models and recognising and knowing your client to assess their competency and maturity.
I make it very clear to the child or adolescent in the initial and if necessary at later sessions that if I believe it is necessary to disclose information to their parents or care givers to ensure they stay safe, that I will do. If the adults can help them by knowing certain information that can and will be shared in a safe and sensitive way, as I cannot keep them safe the remaining 167 hours a week.
I also let the child or adolescent know that professional and safe adults share information, to ensure that everyone can have a more rounded knowledge and understanding of what is happening for them.