ACA Blog

DeeAnna Merz Nagel
Jul 09, 2009

Listservs and Case Consultation- What About Confidentiality?

Are you a member of a listserv?  The most popular Listserv service is Yahoo Groups.  Various organizations and like-minded professionals often create listservs to communicate efficiently with one another.  Once a member, you can usually either opt to receive the emails as they come in or a digest of all of the posts at the end of the day. Many counselor listservs focus on providing a place to network, share resources, find potential referrals and talk about cases. Yes. That is correct…talk about cases. Said differently, counselors talk about their clients on listservs.

The ACA speaks specifically about disclosure of confidential information when consulting with colleagues (Sec. B.8c)  stating that “counselors should not disclose confidential information that reasonably could lead to the identification of a client or other person or organization with whom they have a confidential relationship…disclosing information only to the extent necessary to achieve the purposes of the consultation.”

Here are some points to consider when discussing client-specific information on a listserv.

  1. When asking for a possible referral, keep in mind if you name the town and state the client’s issue (e.g. seeking a referral for a client who lives in Anywhere, TN.  He is struggling with depression after being laid off from his factory job last month) then you potentially disclose enough information to identify the client.

  2. Even when you “blind the record” removing all identifying information, if you talk about a client (e.g. 35 year old female client who has been diagnosed with post partum following the birth of twins 3 months ago) you may reveal the location of the client by way of your very own email signature line. (e.g. Respectfully, Dan Counselor, LPC, Anyone looking up the website can see the counselor’s location and begin to connect the dots.

  3. Not all colleagues follow the same code of ethics or interpret their codes similarly. Some colleagues do not understand confidentiality issues. And haven’t we all been confused with HIPAA compliance at one time or another? If you are on a listserv without a moderator who screens posts, a colleague may post a scenario that reveals much more than the examples given above.

  4. Not all colleagues are ethical. Intentional or unintentional, our colleagues get involved in ethical blunders. So Jane Counselor may see an interesting case description then copy and paste the information to another colleague who is not even on the list.

  5. Clients have a right to know that their case will be discussed, formally or informally.  The most common statement I hear is, “We aren’t doing supervision.”  Peer supervision, case consultation, case supervision, clinical supervision- in the end it boils down to telling another colleague your client’s personal business. Build consultation and supervision into your informed consent.

  6. Consider not participating in listservs that engage in case consultation and consider an encrypted alternative. We are approaching a time when encryption will be standard for all online communication but for now, we must practice due diligence and protect our client’s case material to the extent possible.  Encryption used to be cost prohibitive but that is not necessarily true anymore.

  7. If you decide to remain on a listserv that discusses client information for the purposes of referral or consult, consider educating your listserv colleagues about some of the issues discussed here.

I spoke specifically about listservs in this blog post because many of us are members of listservs and have been for years. But these same points hold true for social networks, forums and other online methods of communication that are not encrypted. Consider providing the best standard of care that you can for your clients.  It may not be as convenient but compare what I am saying to hearing a group of colleagues in a restaurant who are discussing cases over lunch. While they may not be revealing specifics or names, we discourage this behavior, don’t we?

DeeAnna Merz Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute.

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