breaching confidentiality

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breaching confidentiality

Postby bathtub123 » Sun Dec 11, 2016 1:23 am

Can anyone share thoughts?!

...A client discloses historic abuse, but does not share the name of the perpetrator.
...You are aware that a report has already been made and to which authority, which names the perpetrator, and provides an outline of the abuse. And that your client did not give a formal statement but informed children's services.
...Since the report was made, your client learns, and shares with you, that the perpetrator has started to foster children
...You are now aware that it is likely that the information was either not passed to a relevant authority as assured by your client, or perhaps information has slipped through the net.
...with this information, do you contact the authority with whom your client reported concerns? Knowing that by giving the client's name, the perpetrator could be identified - and any information with the potential to protect others could be consolidated - to ensure that other children are protected?
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Re: breaching confidentiality

Postby lingua_franca » Sun Dec 11, 2016 1:52 am

Short answer...YES, absolutely!! Confidentiality is about maintaining safety and dignity, and as such it can't extend to keeping everything private when a child might be at risk. You need to report this immediately. It may be that the client's allegations have already been thoroughly investigated and found to be without foundation, but even so, you can't take that chance.
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Re: breaching confidentiality

Postby maven » Sun Dec 11, 2016 5:43 am

If a child is at risk, you must act to protect them if it is possible to do so. No question about it.

You should tell your client what you are doing, ideally before you report it, but if not after, explaining it is your duty under your code of conduct and contract of employment to do so. And you should have explained the limits to confidentiality at the start of your work with them, including the fact that you have to disclose information that relates to child protection, so you can remind them of this when you do it.
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Re: breaching confidentiality

Postby bathtub123 » Mon Dec 12, 2016 12:29 am

Thank you both.

Does anyone know if its possible for various agencies to pull relevant information together, even without the name of the perpetrator being passed on?
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Re: breaching confidentiality

Postby maven » Mon Dec 12, 2016 5:23 am

I don't know. I hope they can work it out with a process of deduction, and the agency it was reported to kept good records. However, your duty is to pass on the information, they are the ones responsible for what they do with it. If need be, they can ask your client for more information.
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Re: breaching confidentiality

Postby BlueCat » Mon Dec 12, 2016 3:19 pm

As above, short answer is YES, ABSOLUTELY, DO IT NOW!!

Longer answer......without a name, might be difficult for anyone to do anything, but you still need to pass on your concerns.
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Re: breaching confidentiality

Postby Ruthie » Mon Dec 12, 2016 5:06 pm

You don't say who your employer is or what type of organisation you are working for (and I'm not suggesting you do).

However, if you work for the NHS or for a large organisation, then you should have access to someone who is lead for child protection issues. They would be a good person to get advice from and to ensure the right information is passed on to the right people.

These are difficult issues to deal with and it's not something any of us should have to deal with on our own. Your manager should be able to direct you to the right person to help. At the very least, your manager should be supporting you to raise the alert.

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Re: breaching confidentiality

Postby ell » Tue Dec 13, 2016 8:48 am

Child safety trumps all. Speak to your manager and the safeguarding team in your organisation to find out the best way to go about sharing the information, and to get support with it.
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Re: breaching confidentiality

Postby reefflex » Tue Dec 13, 2016 4:54 pm

Yes this falls under Section 11 of the Children's Act - you have a legal duty to do so.

I tend to frame it in this way to highlight that it is not a personal choice but a legal obligation as a healthcare professional

Hopefully in your preamble about confidentiality when you first met the person, you will have explicitly mentioned this provision. I also tend to add in introductions "so if you tell me anything about a child that makes me suspect they may be at risk of harm or neglect, I will assume you have told me because you want me to do something about it". This then gives the patient both informed choice and forewarning about what you can and can't do, when this this kind of information is given in a clinical context.
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Re: breaching confidentiality

Postby bathtub123 » Tue Dec 20, 2016 3:19 pm

Thank you to everyone who has contributed to this thread - all of your comments and thoughts
are incredibly helpful and very much appreciated!
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Re: breaching confidentiality

Postby TaraS » Sat Jan 21, 2017 5:27 am

Moderators note - please read the posts below this one as I have serious concerns about this advice - Maven

I know this was posted a while back but i wanted to share a different opinion

No, I would not make a call.

What exactly would you report? You need the perp's name. Making a report and giving the child's name is basically like asking the child to be unduly investigated and pressurised into naming names. I do feel like that is too far. I dont feel like it promotes the therapeutic relationship at all. It is difficult enough to keep that relationship when the client concedes and allows a disclosure never mind a breach of confidentiality and then further when the overhanging threat is them being investigated. Not least because trying to report this will result in "what do you want us to do when you dont have any info on the perp?" So for the sake of being too quick on the trigger button, youve destroyed the relationship...and potentially the opportunity to actually learn who the abuser is.

Its much better to keep pressing for a name and explain why it is important. Your sessions should include a contract which outlines confidentiality
Last edited by maven on Fri Jan 27, 2017 4:40 am, edited 3 times in total.
Reason: to insert a caution about the advice given in this post, which I believe contravenes our professional obligations
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Re: breaching confidentiality

Postby TaraS » Sat Jan 21, 2017 5:29 am

Also, you can "pass on" your concerns to supervisor or management/safeguarding team without going as far as making a report to nspcc/social services/police. NSPCC actually have a dedicated safeguarding helpline - which i dont have number for because its kept in office of my work, but ive used it and they are very good at helping to make a decision for any action.
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Re: breaching confidentiality

Postby BlueCat » Fri Jan 27, 2017 12:02 am

TaraS wrote:I know this was posted a while back but i wanted to share a different opinion

No, I would not make a call.

What exactly would you report? You need the perp's name. Making a report and giving the child's name is basically like asking the child to be unduly investigated and pressurised into naming names. I do feel like that is too far. I dont feel like it promotes the therapeutic relationship at all. It is difficult enough to keep that relationship when the client concedes and allows a disclosure never mind a breach of confidentiality and then further when the overhanging threat is them being investigated. Not least because trying to report this will result in "what do you want us to do when you dont have any info on the perp?" So for the sake of being too quick on the trigger button, youve destroyed the relationship...and potentially the opportunity to actually learn who the abuser is.

Its much better to keep pressing for a name and explain why it is important. Your sessions should include a contract which outlines confidentiality


Oh my, Tara, you're in dangerous territory there. You're aware of vulnerable children at risk of abuse and you're taking the call not to pass that information to the relevant local authority? In Wales, that would be breaking the law (when there is a legal duty to pass that information on), but wherever you are, that's surely a breach of your duty of care? Child protection trumps all issues of confidentiality, always. If the potential abuser harmed one of those foster children, and an investigation showed that you'd had that information all along but chosen not to pass it on...there would be really serious implications for you.

It isn't for us as clinicians to investigate, or work out who is who and who did what when, it is our duty to support our clients AND to pass on ANY information that comes to us that leads us to believe a child is at risk of harm. I'm also a bit worried about the idea of "pressing for a name" - that is entering investigative territory, rather than therapeutic and is the job of social services not us as clinicians.

I'm wondering if maybe you don't work in the UK? Maybe there are different regulations and expectations where you are, because your advice is so out of whack with what I''ve come to understand as the correct way to proceed in these types of situations?
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Re: breaching confidentiality

Postby lingua_franca » Fri Jan 27, 2017 3:27 am

Tara, what you are suggesting - "pressing" the child yourself - actually goes against best practice in safeguarding and could contaminate the evidence if any charges were to be brought. In all safeguarding training I've ever received we were taught not to push for information, but to avoid any question that could be construed as leading and simply write down and report what the person says. The limits of confidentiality (and the difference between confidentiality and secrecy) should be explained to every client at the outset - this is especially important for young people who may have been taught to hide things and have a confused understanding of what it means to "keep a secret" because of prior abuse experiences. In fact, I would worry that a well-meaning therapist who didn't pass on the info for fear of damaging the therapeutic relationship might be compounding the "our secret" dynamic that is often part and parcel of sexual abuse. That child might well be ambivalent about reporting the abuse, but in spite of their ambivalence they could be testing out how a safe adult behaves, and trying to see whether their cry for help will be heard.

You seem to have a very negative view of child protection services. I've never met a social worker who would "pressurise" a child for information. They're trained to deal with abuse allegations in a sensitive way, and they're held to a high professional standard. It's their responsibility to deal with allegations like this and they need to know.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
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Re: breaching confidentiality

Postby miriam » Fri Jan 27, 2017 4:36 am

I read the OP as asking for advice about a situation in which they were working with an adult who was abused in childhood and had mentioned the perpetrator was now a foster parent, yet some people are responding as if the OP is working with a child. Either way, I would agree with Bluecat and others who have expressed concern about the advice that this does not need to be reported. It is my professional opinion that this information has to be reported.

The admins have also had a discussion with the OP and can confirm that the advice to report the concerns was correct, and has been followed.

I want to communicate that as the owner of this site and someone who has written best practise guidance for the BPS and been involved with child protection for 20+ years now, I would be very concerned about anyone following TaraS's advice. It is our professional responsibility to report any concerns about a child being at risk, and not to take the role of investigating, probing, or deciding whether it meets the threshold for action. Whether or not social services act on a report is up to them, but whether we report it is down to our legal obligations and code of practice which both say very clearly that the threshold is believing a child could be at risk. If you have reason to think, as this OP does, that a person who has sexually abused a child is currently fostering children, you cannot withhold that information and have a duty to report it immediately and allow social services to follow up to gather information or take action as they think appropriate.

I should also say at a personal level, that the last "borderline" concern about sexual abuse from my own clinical work was one that I discussed in peer supervision, wondering whether and when to report because of the lack of evidence. Long story short, I did report it and the social worker investigating it pulled on my thread of concern which unravelled to lead to child sexual abuse charges including rape being filed. It still gives me chills that if I had waited longer to report it (let alone not reporting it at all) that child may have experienced more abuse. I would never want to live with that responsibility. Reporting concerns that are not taken any further or are investigated but not substantiated does not harm a child. Failing to report concerns may leave a child in an abusive situation. It is our professional and moral obligation to make a report as soon as we become aware that a child might be at risk.
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