A question of confidentiality

November 7, 2001 in Child safeguarding, Pay and conditions, Social care leaders

The
Challenge

The
debate over whether advocates should be able to offer children and young people
a higher level of confidentiality than social workers has delayed for more than
a year the issuing of national standards for advocates working with children.
Advocacy workers are clear that they must represent the child’s wishes and be
able to offer children the safety of high levels of confidentiality. What can
the panel suggest?

John Kemmis, chief executive, Voice for the Child in Care

PANEL RESPONSES

Anthony
Douglas
Advocates have to be able to gain the confidence of young people. That is often
impossible if every discussion has to start with a confidentiality proviso.
While young people will sometimes talk of abuse they have suffered, or offences
they have committed, the key role for an advocate is to get alongside a young
person and help them to make their own decisions.

Overriding
confidentiality may be justified only if either the young person or other
vulnerable people would be placed at great risk by the advocate remaining
quiet. Few situations are as clear cut as this, and statutory agencies should
recognise and respect the advocate’s need for discretion.

The
demand for advocates is even greater as staff in statutory agencies are
constrained by procedures that make the reporting of abuse or offending
mandatory. Despite this, front-line staff as well as advocates need to be able
to build trust with young people, and that can involve being tested out with
confidences and being seen to respect them.

Advocates
need to spell out to the young people they work with that while their role is
primarily supportive, they also have a duty of care which, at times, may place
them in conflict with the person they are supporting. If a teenager tells you
they have just taken an overdose, you get them straight to hospital whatever
they say. An advocate has an uneasy role, full of grey areas – part-parent,
part-teacher, part-social worker, and part-friend. We need more advocates and mentors
for troubled young people, so we have to make advocacy viable.

Daphne
Obang
Like all other principals who work with vulnerable children, the advocate must
respect the confidentiality of information given by young people in the course
of interaction. The function of the advocate as a proxy for the voice of the
child does not, however, negate a role shared by all other professionals – the
ultimate protection of the child.

There
can be a tension between the duty of confidentiality (advocate) and whether a
minor (the young person) can give informed consent for disclosure. There will
be times when protection will involve some soul-searching decision-making about
disclosure of information. In working with statutory organisations advocates
will have to decide whether they agree there are limits to confidentiality and
what those limits are.

One
consideration should be the determination of risk leading to harm or danger for
the young person or others. Another issue will be to whom the information of
risk should be disclosed and, most importantly in a multi-disciplinary
environment, who should define both the risk and the degree or level of risk.

The
recommendations of the Caldicott Committee give guidance on joint working and
confidentiality that can be equally applied to work with young people. These
include the need to establish and monitor joint protocols about the sharing of
information and a possible requirement that individuals and agencies can
demonstrate through accreditation their commitment to the principles of
confidentiality.

There
need not be the implied conflict as long as the interests of the young person
and not "role protection" remain paramount.