Maintaining Confidentiality

Focus Areas
❒ The privacy rights of youth and protocols for upholding those rights;
❒ The definition of confidentiality, HIPAA laws, breach of confidentiality, and other clarifying information;
❒ Staff consequences for breaching confidentiality;
❒ Where and how to store sensitive information and medical records; and
❒ Procedures for sharing confidential information.

Ensure staff are well-informed about the privacy rights of youth and that they are aware of procedures and protocols for upholding those legal rights.
The Health Insurance Portability and Accountability Act (HIPAA) passed in 1996 requires the protection and confidential handling of protected health information, which includes reproductive and sexual health care. Staff members should be aware of what is considered confidential information and who is allowed access to it. Protocols should include where and how to store information, as well as, how to securely share confidential information.

Staff should never share private and confidential information in front of other youth, staff, and/or visitors in the home or in public spaces. It is the youth’s legal right to receive health services confidentially. Youth can specify what information they are comfortable with being shared, and what information they would like kept confidential. A clinic or doctor cannot legally disclose any information including the purpose of the youth’s visit without the youth’s consent. Staff should not enter or join a health or telehealth appointment of the youth without the youth’s permission. Youth have the right to confidentiality of medical and mental health records, including, but not limited to, HIV status, substance use disorder history and treatment, and sexual and reproductive health care, consistent with existing law.

Youth have the right to make, send, and receive confidential telephone calls and other electronic communications, and to send and receive unopened mail, unless prohibited by court order. Additionally, a youth’s privacy regarding sexual orientation, gender identity and expression (SOGIE) must be maintained, unless: the youth permits the information to be disclosed, disclosure is required to protect their health and safety, or disclosure is compelled by law or a court order. A violation could lead to a licensing complaint and review of the organization.

Assist youth in accessing copies of their personal health records and information from their health providers, in compliance with state law. Current and former foster youth have the right to view and receive a copy of their child welfare records, juvenile court records, and
educational records at no cost until age 26, subject to existing federal and state confidentiality laws. Staff should assist youth in obtaining any of these records from the necessary party.

Tips for Maintaining Confidentiality
Resources are available to help staff and youth understand rules related to confidentiality. All County Information Notice (ACIN) I-06-20 (see next topic) includes frequently asked questions and talking points for how to explain confidentiality and its limits with youth, including that related to reproductive and sexual health information. A complete list of All County Letters and Information Notices from CDSS on reproductive and sexual health is available on the Resources webpage for the CDSS Healthy Sexual Development Project. The toolkit, Understanding Confidentiality and Minor Consent in California, can help staff and providers appropriately support youth in their health-related decisions and in developing autonomy as a
patient