Sharing information among the variety of staff involved in barrier identification requires that all persons involved give special attention to issues of confidentiality. As noted in Ten Important Questions, developing strategies for identifying unobserved barriers brings to the forefront questions regarding what information can be shared, under what conditions information can be shared, and how information should be shared. A number of different federal and state laws, as well as regulations, guide the protection of privacy, the confidentiality of records, and informed consent.
When asked, staff in all of the study sites appeared familiar with their offices’ guidelines regarding confidentiality and information sharing. Staff could easily and quickly produce the forms clients were asked to sign to facilitate information sharing. In many cases, TANF agency staff asked clients to sign these forms very early in the process to allow greater latitude to share information as it was uncovered.37 In some cases, staff of partner agencies appeared more familiar than TANF agency staff with the details of these provisions and the need to obtain informed consent from clients before sharing information with the TANF agency.
Generally, specialists reported sharing only the information they believed was relevant with TANF staff. TANF staff occasionally reported frustration regarding obtaining information from specialists—particularly those in the substance abuse and domestic violence fields. This appears to be due to several factors including the special confidentiality provisions that guide sharing of information regarding substance abuse, and the fact that many domestic violence service providers also serve as advocates for their clients and place clients’ interests above those of the TANF system. TANF case managers’ frustration appeared to be rooted in the fact that, in accepting responsibility for the case, case managers often believe that they should have the broadest set of information available, whether or not it related to TANF eligibility or service strategies.
The study sites illustrate that the challenges associated with ensuing privacy and confidentiality are not insurmountable.
Staff reported that clients rarely objected to signing release or informed consent forms. In a few cases, staff attributed this to their strategy of informing clients how the information would be used, with whom it would be shared, and under what conditions. More commonly, staff asked clients to sign release forms as part of a process that requires the completion of many forms. Staff acknowledged that clients may not fully understand the implications of signing different forms. It is unclear from these staff reports if clients are willing to sign the forms because they have no concerns about how information will be used or with whom it will be shared, or, if as indicated in the focus groups, clients sign the required forms so as not to jeopardize their eligibility for benefits and consider these confidentiality issues when deciding what to disclose and to whom.
Although confidentiality provisions and agreements deserve a more detailed review than offered by this study, it is clear that the challenges associated with ensuring privacy and confidentiality are not insurmountable. States and localities engaged in developing unobserved barrier identification strategies should not view issues of confidentiality as a barrier to the implementation of proactive screening and assessment strategies.
37 Our exploration of this issue did not include a detailed review of the forms, time period specified for allowable information sharing, or other details related to the use of these signed consent forms.