Full Answer Section

Client Population: The Guiding Hand serves a diverse population of individuals and families experiencing homelessness, including single adults, families with children, veterans, individuals with disabilities, and those struggling with substance abuse or mental health issues.

Scenario: Breach of Confidentiality

Characters:

• Maria: A case manager at The Guiding Hand.
• David: A client of The Guiding Hand, struggling with addiction and recently housed in transitional housing.
• Sarah: A volunteer at The Guiding Hand, assisting with administrative tasks.

Nature of the Violation: Maria, while discussing David’s case with her supervisor in a break room, inadvertently leaves David’s case file open on the table. Sarah, passing by, notices the file and sees sensitive information about David’s addiction history and mental health diagnoses. Sarah, without malicious intent, mentions to another volunteer that “David has been through a lot.” The other volunteer infers that David has a substance abuse problem.

Discovery: David overhears the other volunteer talking about his “issues” in the common area and realizes that his confidential information has been shared without his consent. He feels betrayed and humiliated.

Relevant NOHS Ethical Standards:

• Standard 1: Clients: Human service professionals’ primary responsibility is to the clients they serve. This scenario violates this standard by failing to protect David’s confidentiality.  
• Standard 2: Confidentiality: Human service professionals respect the privacy and confidentiality of clients. Sharing client information without consent is a direct violation of this standard.
• Standard 3: Data and Information: Human service professionals protect the confidentiality of all information pertaining to clients. Leaving the file open in a public space and the subsequent disclosure of information are both breaches of this standard.  
• Standard 6: Integrity: Human service professionals are honest and trustworthy. Maria’s unintentional but careless handling of the file and Sarah’s subsequent, albeit unintentional, disclosure compromise the integrity of the organization and the client-professional relationship.

Analysis of the Ethical Violation

Personal Responsibilities and Ethical Duties:

• Maria: Maria has a professional and ethical duty to safeguard client confidentiality. Her actions, though unintentional, demonstrate a lapse in professional judgment and a failure to adhere to agency protocols regarding client information.
• Sarah: While Sarah’s disclosure was unintentional, she has a responsibility to respect client privacy. Even casual remarks about a client’s situation can lead to breaches of confidentiality.
• David: David is the victim of the ethical violation. His trust in the organization is compromised, and he experiences emotional distress due to the breach of his confidentiality.
• Bystanders/Other Volunteers: They have an ethical responsibility to speak up if they witness an ethical violation, either to the individuals involved or to a supervisor.

Impact on the Organization:

• Organizational Culture: This breach can erode trust in the organization and create a climate of fear among clients that their information is not safe.
• Trust: Clients may be less likely to seek help if they fear their confidentiality will be compromised.
• Legal Ramifications: The organization could face legal action for violating privacy laws (e.g., HIPAA, if applicable).
• Public Perception: Negative publicity surrounding the breach could damage the organization’s reputation and make it harder to attract clients, funding, and qualified staff.

Response to Ethical Violations

Immediate Actions:

• Maria should immediately apologize to David for the breach of confidentiality and acknowledge her mistake.
• Sarah should be reminded of the importance of maintaining client confidentiality and provided with further training.
• The supervisor should be informed of the breach.

Investigation Procedures:

• The supervisor should conduct a thorough investigation into the incident, interviewing all involved parties.
• The organization’s ethics committee (if one exists) should be consulted.
• The investigation should determine the extent of the breach and identify any systemic issues that contributed to it.

Long-Term Strategies:

• Policy Review: The organization’s confidentiality policies and procedures should be reviewed and updated as needed.
• Staff Training: All staff and volunteers should receive comprehensive training on ethical standards, confidentiality protocols, and best practices for handling client information. This training should be ongoing and reinforced regularly.
• Supervision and Monitoring: Supervisors should provide regular oversight to ensure that staff are adhering to ethical guidelines.
• Culture of Ethics: The organization should foster a culture that prioritizes ethical conduct and encourages staff to report ethical concerns without fear of retaliation.
• Remediation for David: The organization should offer David appropriate support, such as counseling or other services, to address the harm caused by the breach of confidentiality. They may also want to explore restorative justice practices.

By taking these steps, The Guiding Hand can address the immediate ethical violation, prevent future occurrences, and rebuild trust with its clients and the community.