1 SUBSTANCE ABUSE TREATMENT CONFIDENTIALITY National Center on Substance Abuse & Child Welfare February 17, 2004

2 Lori Nelson, a DCFS referred mother, scheduled an assessment and doesn’t show or cancel. Dave the assessor wants to contact the referral source to notify them that Lori did not follow through. Dave is not sure what to do because he does not have a signed release of information. Does Dave need consent to share the information with the referral source (DCFS)? If DCFS indicates Lori gave verbal consent, can Dave share the information? In cases of court-ordered referrals (DCFS, TANF, TASC) do rules differ? If Lori were a 14-year old, could Dave tell her parents? Vignette #1

3 You receive a report from a substance abuse counselor concerning Raina, a client who had been court-ordered to treatment. DCFS is currently investigating Raina’s fitness to have custody of her children. The counselor reports that Raina walked out of the treatment center after telling the counselor that she had no intention of quitting her cocaine use, that she’s been using cocaine everyday in treatment and that she only came into treatment because of the threat of the judge taking away her kids. As she leaves the facility, Raina says “I revoke my consent – Ha-ha you cannot tell the judge”. Vignette #2 Is Raina’s verbal revocation of consent legally valid? What should the treatment provider have said or not said to you? Does the treatment provider have a right and/or obligation to notify DCFS?

4 You are a DCFS case worker. During your testimony in a custody proceeding, the state’s attorney asks you to indicate whether the mother, Liz, is receiving or has received substance abuse treatment. You are aware that Liz recently voluntarily enrolled in an outpatient treatment program for her methamphetamine addiction. The treatment program shared the information with you after obtaining Liz’s signed consent to disclose information to DCFS and DHS for case management and discharge planning purposes. Can you testify about your knowledge of Liz’s addiction and/or treatment? If you refuse to answer, can the judge order you to answer? If she does, how should you respond? Vignette #3

5 You have been subpoenaed to testify in a termination proceeding. You know that both birth parents have received treatment for drug and/or alcohol addiction in the past, but over the course of your assessment, you were pleased that you saw no signs of relapse by either parent. The day before the hearing, you see the father in a local bar, drinking heavily and visibly intoxicated. The father begs you not to tell anyone, and says that he drank “just this once” because he was nervous about the hearing. What do you say to the father? To whom may you disclose what you saw? Must you tell the court what happened, even if you are only asked about your formal report? Vignette #4

6 Jan is a 15-year old new mother whose mother is participating in your program. Jan’s mother has a history of heroin addiction. Jan contacted her case worker requesting counseling services for problems that include her drug use. She is adamant in her refusal to allow you to share this information with her mother, or to include it in any report to DCFS. Jan fears that if she seeks treatment, her child will be removed from her care, just as she was once removed from her mother’s care. Jan swears that she will seek counseling only under the condition that you tell “nobody”. You believe she needs help. Vignette #5 How would you respond to this situation? Does Jan have a legal right at age fifteen to consent to treatment services? Who, if anyone, would you tell about Jan’s drug use? Do you have any ethical or legal responsibilities to Jan’s mother in this situation?