CONFIDENTIALITY 

In general, the privacy of communications between an Adult patient and a mental health provider are protected by law, and we can only release information about our work with you to others with your written permission; however, there are exceptions. Typical exceptions include when there is concern of risk to yourself or others, we become aware of child abuse or neglect, or we are required by law or court order to release your information. In addition, please note that different types of providers are guided by different elements of HIPAA; for example, the confidentiality of medical care (e.g., medication management) is different from the confidentiality of therapy.

The primary law that governs your confidentiality is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). You may learn more about your rights under HIPAA through the US Dept of Health & Human Services. Below is our summary of the relevant portions of HIPAA and our policies as it relates to abiding by these laws.

In most legal proceedings, you have the right to prevent your provider from providing any information about your treatment; however, in some legal proceedings, a judge may order a provider’s testimony if they determine that the issues demand it, and we must comply with that court order. In addition, we may be required to provide information about your treatment to comply with requests from government agencies such as the Department of Social Services or Child Protective Services.

There are some situations in which we are legally required and/or ethically permitted to take action to prevent harm. If a patient threatens to harm themselves, we may be obligated to seek hospitalization for that person or to contact family members or others who can help provide protection. If a similar situation occurs in the course of our work together, your provider will make reasonable efforts to fully discuss it with you before taking any action. If we believe that a patient is threatening serious bodily harm to another, we may be required or permitted to take protective actions. These actions may include notifying the potential victim, contacting the police, and/or seeking hospitalization for the patient.

There are other circumstances where we are legally obligated to make a report based on information you give us in the course of services. Mental health providers are generally considered mandated reporters in any laws that designate mandatory reporting. Laws in North Carolina are evolving and we recommend you familiarize yourself with laws that require mental health providers to disclose your or your child’s personal information to government agencies or law enforcement. The most common mandated reporting situations involve requirements to protect vulnerable populations from abuse or neglect (e.g., child protective services) and involve reporting to a protective agency (e.g., Child Protective Services). Whenever it can be done safely and ethically, your provider will discuss with you if/when they need to make a report. If you are unsure of what your provider needs to report, they would be happy to discuss this with you in more detail.

Your provider may occasionally find it helpful to consult other professionals about your services with us. For example, TAP providers regularly for the purpose of case consultation with the goal of providing wraparound care. A TAP provider may also seek consultation with an expert outside of TAP, during which they would consult without using identifying information (e.g., your name). Consultation with relevant experts (both inside and outside of TAP) is considered an integral part of excellent clinical care and helps ensure that you are receiving the best possible treatment. During a consultation, the consultant is legally bound to keep the information confidential. Ordinarily, your provider will not tell you about these

consultations unless they believe that it is important to your work together. We require TAP Clinic providers to be able to communicate with each other and with outside consultants without additional consent from you. We agree to use the minimal amount of health information necessary to obtain the needed consultation. Please note that consultation is different from coordination of care, which involves speaking in depth with current or previous providers involved in your care and in which the care provider is aware of identifying information (e.g., your name). Coordination of care is bound by HIPAA and all providers will follow the appropriate guidelines regarding your confidentiality and obtain releases of information if required.

RECORDING 

Your care at the TAP Clinic will not be audio or video recorded without your prior consent. Similarly, we expect that all patients respect the privacy and confidentiality of TAP staff and other patients or families. By signing this agreement, you agree not to use any video or audio recording devices, take photos, or livestream while physically or virtually in the TAP Clinic. If you would like to record an individual session for your personal learning purposes, you agree to obtain the consent of your TAP provider prior to recording.  Violations of this policy may be grounds for termination of treatment.

SURVEY MEASURES

As a standard part of our practice, we may ask you to complete measures to evaluate symptoms and behaviors. Such measures help providers determine baseline symptoms, as well as track symptom progression and/or therapy progress over time. We believe that such measures are one useful way to assess and modify treatment interventions, as well as facilitate discussion of your progress in treatment. If measures are used, your provider will explain the method (e.g., patient portal) or app (e.g., diary cards) that will be used and you will be given the opportunity to accept or decline.

Minor Patient Addendum

INDIVIDUAL PARENT/GUARDIAN COMMUNICATIONS WITH THE PROVIDER

Over the course of treatment, the provider may meet with the youth’s parents/guardians either separately or together. Please be aware that the patient is the youth – not the parents/guardians nor any siblings or other family members of the youth. If the provider meets with you or other family members in the course of your child’s treatment or assessment, we will make notes of that meeting in your child’s treatment records. Please be aware that those notes will be available to any person or entity that has legal access to your child’s treatment record. In addition, please be aware that any information communicated to the provider about the minor may be disclosed to the minor patient and, if clinically appropriate, to any other legal guardians. Except under exceptional circumstances, clinically relevant disclosures by legal guardians are not “secrets” kept by the provider; please be aware that any relevant disclosures may be communicated directly to the youth and/or the other legal guardian(s) involved.

MANDATORY DISCLOSURES OF TREATMENT INFORMATION

In some situations, we are required by law or by the guidelines of our profession to disclose information, whether or not we have your or your child’s permission. Some of these situations are listed below.

Confidentiality cannot be maintained when:

• Minor patients tell a provider they plan to cause serious harm or death to themselves, and the provider believes they have the intent and ability to carry out this threat in the very near future. The provider must take steps to inform a parent, guardian, or others of what the youth has said, and how serious s/he believes this threat to be and to try to prevent the occurrence of such harm.
• Minor patients tell a provider they plan to cause serious harm or death to someone else, and the provider believes they have the intent and ability to carry out this threat in the very near future. In this situation, the provider must inform a parent or guardian or others, and the provider may be required to inform the person who is the target of the threatened harm, as well as the police.
• Minor patients are doing things that could cause serious harm to them or someone else, even if they do not intend to harm themselves or another person. In these situations, the provider will need to use professional judgment to decide whether a parent or guardian should be informed.
• Minor patients tell a provider, or the provider otherwise has reason to believe that the minor patient is being neglected or abused--physically, sexually or emotionally--or that it appears that they have been neglected or abused in the past. In this situation, the provider is required by law to report the alleged abuse to the appropriate state child-protective agency. Though we strive to discuss this with parents before the agencies are notified, this is not always possible given the timeline governing the report (e.g., we often have 24 hours), the content of the disclosure, or the degree to which the patient reports belief that they will be punished for the disclosure.
• The provider is ordered by a court to disclose information.

DISCLOSURE OF MINOR’S TREATMENT INFORMATION TO GUARDIANS AND/OR PARENTS 

Mental health services are most effective when a trusting relationship exists between the provider and the patient. Privacy is especially important in earning and keeping that trust. As a result, it is important for minor clients to have a “zone of privacy” where they feel free to discuss personal matters without fear that their thoughts and feelings will be immediately communicated to their guardians. This is particularly true for adolescents who are naturally developing a greater sense of independence and autonomy.

It is our policy to provide you with general information about your child’s treatment, but NOT to share specific information your child has disclosed without your child’s agreement. This includes activities and behavior that you might not approve of — or might be upset by — but that we believe do not currently put your child at risk of serious and immediate harm. However, if your child’s risk-taking behavior becomes more serious, then the provider will use his/her professional judgment to decide whether your child is in serious and immediate danger of harm. If the provider feels that your child is in such danger, s/he will communicate this information to you.

At times, the provider may believe that it is important for you to know about a particular situation that is going on in your child’s life. In these situations, we generally will encourage your child to tell you, and we will help your child find the best way to do so. Also, when meeting with you, we may sometimes describe your child’s problems in general terms, without using specifics, in order to help you know how to be more helpful to your child.

Different services may warrant a different level of disclosure to guardians and your provider(s) will discuss with you their policies and expectations during an intake process. For example, therapy relationships often afford more privacy to the youth than an assessment.

DISCLOSURE OF MINOR’S TREATMENT RECORDS TO PARENTS

Although the laws of North Carolina may give parents the right to see any written records the provider keeps about your child’s treatment, it is TAP’s policy to protect some of these records within your child’s “zone of privacy” except in unusual circumstances (or as required by law). The “zone of privacy” varies by service provided, but we generally seek to disclose the minimal amount of a medical record necessary to coordinate care or otherwise provide effective services to your child.

If you request access to your child’s written therapy records, your provider will seek to understand the goal of this release and whether any less invasive means of disclosure (e.g., a written summary or a phone call) are sufficient. Records of medical care (e.g., medication management notes) and written assessment reports do not fall under this “zone of privacy” and will be disclosed to you upon request unless not permitted by law or ethical code.

Multi-Patient Addendum

CONFIDENTIALITY

In addition to the standard confidentiality policies, multi-patient treatments present the additional complication of the degree of confidentiality between patients actively participating in the therapy itself (e.g., the other partner, parent, or family member). The TAP Clinic has a "no secrets" policy among the regular participants in mult-patient treatment with very few exceptions. This means that anything one person shares with the treatment provider must be allowed to be shared with all participating in the therapy. This is important to foster trust among all patients participating and allows the therapist to directly target any disclosed information in treatment. The therapist will use their discretion as to how much and in what manner to share the disclosed information with the other patients in the treatment; that is, what you share may not be disclosed verbatim and will be done in an age-appropriate and treatment-appropriate manner. However, we do not ask our therapists to keep important, treatment-relevant information from the other patients in the couples, parenting, or family treatment unless that confidentiality is required to keep one of the patients safe (e.g., domestic violence).

ACCESS TO RECORDS

If your name is on the chart, you “own” the record - meaning that you can get a copy of it if you want or need to for some reason, or you can provide consent for the therapist to release those records to another party or provider. Thus, if we include all regular participants in therapy on the chart, all participants would have equal access to the chart during and after therapy concludes, and they must all consent to releasing any notes. Similarly, if you elect to use an individual's name on the chart (rather all multiple patients), this will mean that only that person listed has access to and can deny others access to that chart. If this is a minor child (e.g., when parent training is focused on managing the child’s behavior), the child will own the record when s/he reaches the age or majority. From a clinical standpoint, we ask that all participants agree that all parties have access to the chart equally, both during therapy and after the therapy has ended.