Confidentiality when working with families, couples, and parents of young patients can be a tricky maze of ethical standards and exceptions (Ellis, 2012). Because each situation is different, there is no hard and fast rule pertaining to ownership of medical records when there are multiple individuals involved in counseling sessions.
School guidance counselors face the same dilemma when parents request full access to their child’s counseling records. Nancy Bodehorn surveyed a group of guidance counselors at the elementary, middle school, and high school level.
The purpose of this exploratory study was two-fold: to determine counselors’ perception of the most common, as well as, most challenging issues regarding confidentiality; and to ascertain if there are differences of those perceptions across the differing academic levels. This information was then compared inquiries previously conducted over the past thirty years to analyze trends across multiple investigations.
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Participants were selected through a stratified random sampling of schools in the Virginia public schools system. Three-hundred schools, comprised of 100 schools at each academic level, received surveys address to the school guidance counselor at each. Each packet contained the survey, full disclosure of the study, and letters of consent. Of the 300 surveys mailed, 92 school counselors completed and returned the survey.
Approximately half of participants included anecdotal evidence of ethical breaches and the legality of disclosing student records, especially in the events of divorce and custody battles. Additionally, incidents of colleagues requesting confidential information and reports to child protective services were addressed in eight of forty-four written scenarios.
The most challenging ethical dilemmas reported by school guidance counselors pertained to student confidentiality, duty to report harm to self or others, ethical breaches by colleagues (including teachers), rights of parents to view students’ records, and dual relationships with students and/or faculty.
Of these five categories, 46% of participants reported student confidentiality of personal disclosures and 45% of participants stated that reporting intent to harm self or others were the most difficult issues. Parental rights and breach of confidentiality by colleagues were ranked similarly with 33-34% respectively. Only 19% of participants indicated that dual relationships with students or staff were a concern.
The most common occurrences of ethical dilemmas included confidentiality of student disclosures and records, reporting intent to harm, parental rights, and dual relationships. Sixty-seven percent of guidance counselors reported concerns for confidentiality of student disclosures.
Approximately one-third of participants indicated common occurrences of situations concerning student records and disclosing intent of self-harm or harm to others. Frequency of issues pertaining to parental rights and dual relationships were reported by approximately 20% of participants.
When comparing responses across the stated academic levels, it was determined that more middle school guidance counselors reported concerns surrounding dual relationships than either elementary or high school counselors.
Data from this study is consistent with concerns relating to patient confidentiality in the counseling community as a whole. Because of the gravity of these concerns, the American Counseling Association attempted to provide further guidance in the 2004 ethical codes (ACA, 2004).
Issues pertaining to confidentiality were addressed in sections A.2.g and B.1.a stating the primary obligation is to the student; however, parental rights concerning minor-aged children should be respected. School guidance counselors were also encouraged to build collaborative relationships with parents in an effort to provide optimal opportunities for student growth.
School guidance counselors are also tasked with protecting student confidentiality through the Family Educational Rights and Privacy Act (US Department of Education, 2015). FERPA guidelines define who may have access to student educational records and mandate annual notification to guardians of students. As with any therapeutic relationship, confidentiality may be broken in cases of abuse of children, imminent self-harm, or impending harm to others.
Only one-third of surveyed school guidance counselors contributed to this exploratory study which led to a very small sample population. Due to this, subgroups such as gender, ethnicity, and school locality were not equally represented. Additionally, only counselors in the state of Virginia were included in the study. Because state regulations vary, extending the range to include counselors from other states could have offered more insight to perceived challenges.
Another issue that may have affected participation is the method of gathering data. Survey packets were mailed to schools at varying times of the academic year; spring for elementary and middle school, fall for high school. Schedule testing was identified as a reason for surveying high school guidance counselors in the fall.
What Bodenhorn failed to realize is that elementary students and middle school students are also included in standardized testing. In smaller schools, guidance counselors are often used as test administrators and proctors, thus limiting time counselors would have to complete such questionnaires.
Additionally, fall is an extremely busy time for high school guidance counselors as many are tasked with creating student schedules. As an educator of over 25 years, it is this writer’s opinion that there isn’t “down time” for school guidance counselors at any academic level.
Privacy of student records continues to be a grey area as does the confidentiality of minor-aged clients, individual members of families and couples receiving counseling services.
Mental health professionals, regardless of the employing agency, are tasked with protecting their clients; this often includes maintaining confidential, detailed records of matters discussed between the client(s) and counselor. When marital discord and custody of minor children are involved, counselors and therapists are often plunked down in the middle of the melee.
Research on this particular dilemma indicates that there are discrepancies among state statutes regarding access to counseling records. This writer is familiar with the pressure associated with protecting the individual (student) while complying with legal demands. There is no “one-size-fits-all’ solution to this quandary.
As professionals, we have to scrutinize each situation carefully, confer with other professionals, and do what we feel is best for our clients.
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