Patient Rights: An Advocate's Perspective

Abstract

The current growing concern about patients' rights and the delivery of student health care precipitates an environment of fear, distrust, and uneasiness within university health services. This paper addresses several selected clinical, ethical, and legal issues which have come into conflict during recent years. Our examination surveys ethical and legal principles of confidentiality, defines areas in which breaches are most likely to occur, and suggests ways of preventing breaches of confidence between students and health services.

While the fundamental ethical principle underlying confidentiality is the individual's right of privacy, many issues of confidentiality are extremely difficult to resolve. University health services have expanded the concept of health care to encompass all the conditions — medical, emotional, social, economic and environmental — which affect the health of students. As a result, health service administrators should be fully aware of the laws and associated legal complexities in their own state which affect confidentiality. Furthermore, student health physicians, and particularly mental health therapists must be sensitive to needs for protecting the privacy of students.

Legal principles of confidentiality discussed in this paper with respect to specific problem situations which might arise in a student health center include: 1) right to privacy; 2) privileged communications; 3) releasing information from the medical record; 4) releasing information to the student; and 5) treating minors without parental consent. Finally, in addition to the responsibilities which must be assumed by the health professional, certain student responsibilities in the selection and utilization of health professionals are recommended.     

Liability and the Internet: Risks and Recommendations for Social Work Practice

SUMMARY

Use of the Internet for counseling and information services has increased dramatically in the last five years. Although the Internet may benefit consumers by helping them secure needed services and resources, social workers and social service agencies who provide counseling over the Internet need to be aware of the legal risks associated with its use. Among the most salient concerns that need to be addressed are client confidentiality and privacy of records, appropriateness of treatment services, and the duty to warn others of harm that a client might pose to them. This paper looks at these legal concerns in light of appropriate Social Work practice and recommends methods to abate the risks that might occur when Internet counseling and service is provided.     

Beyond privacy: bodily integrity as an alternative framework for understanding non-consensual pornography

ABSTRACT

Activists and legal scholars seeking remedies to non-consensual pornography (known colloquially as ‘revenge porn’) have generally framed it as a violation of privacy; however, the concept of privacy a fraught history, linked to women’s exclusion from the public sphere, denial of their sexual expression, and impunity for abusers. I argue that the concept of body integrity better maps onto the experiences described by victims, who seldom distinguish between digital representations of their body and the body itself and who often liken non-consensual pornography to sexual assault. However, a feminist approach to bodily integrity (rather than one rooted in classical liberalism) is require in order to account for the disproportionately negative consequences non-consensual pornography has for women.     

Patient Rights: The Yale Experience

Abstract

The development of a policy of confidentiality and privacy at the Division of Mental Hygiene, Yale University Health Services, is traced from the earliest reference to it in 1933 through the present. The factors relating to confidentiality within the university are distinguished from those relating to inquiries from outside agencies. The distinction between information requested in connection with further therapy and information requested for use in evaluation for employment or selection is made. In the latter instance, the establishment of a policy of releasing no information to outside agencies, even with a waiver from the patient, is described and explained.     

Disclosure of sexual assault experiences among undergraduate women at historically black colleges and universities (HBCUs)

ABSTRACT

Objective: To document the sexual assault disclosure experiences of historically black college or university (HBCU) students. Participants: A total of 3,951 female, undergraduate students at 4 HBCUs. Methods: All women at the participating schools were recruited in November 2008 to participate in a Web-based survey including both closed- and open-ended questions. Survey data were weighted for nonresponse bias. Results: The majority of sexual assault survivors disclosed their experience to someone close to them, but disclosure to formal supports, particularly law enforcement agencies, was extremely rare. Nonreporters had concerns about the seriousness of the incident and their privacy. On the basis of qualitative data, strategies identified by students to increase reporting included more education and awareness about sexual assault, more survivor services and alternative mechanisms for reporting, and better strategies for protecting the confidentiality of survivors. Conclusions: Official sexual assault victimization data are of limited utility in conveying the extent of sexual assault among HBCU students, and efforts to increase reporting, such as peer education and enhanced confidentiality procedures, are needed.     

Social Workers’ Preparation for Child Protection: Revisiting the Question of Specialisation

Abstract

Child welfare work is a key field of practice for social work graduates and for graduates of a growing range of disciplines. In the present paper, the authors drew on a survey of 208 child welfare workers and interviews with 28 senior personnel in child and family welfare agencies to analyse perceptions of the educational preparation of social workers and other human science graduates for this field of practice. The findings indicated that child welfare workers and employers are ambivalent about the value of social work and other generic social science and human services programmes as preparation for tertiary or statutory child protection practice, which involves investigation, assessment, and intervention in child abuse and neglect. The authors argue that the social work profession must better balance generic and specialist aspects to prepare graduates for practice in specialist fields of high social work involvement, particularly in tertiary child protection work.     

University efforts to address confidentiality issues for STI services

Abstract

Objective: This study assessed university policies for addressing confidentiality issues for students seeking STI services. Participants: Universities with sponsored health insurance plans (SHIP) and/or wellness centers were selected from a university health services survey in 2017. Methods: STI service coverage and polices for addressing confidentiality issues related to explanation of benefit (EOB) forms were stratified by institution type (4-year versus 2-year) and minority serving institution (MSI) status. Rao-Scott chi-square tests were used to assess for differences in STI service coverage and polices. Results: More non-MSIs (61.6%) had SHIPs compared to MSIs (40.0%, p?<?.001). Only 40.8% of health centers had a policy for addressing EOB-related confidently issues. Of those, the most reported policy was that students could pay out-of-pocket to avoid generating an EOB (36.2%). Conclusions: Reducing confidentiality barriers are important for STI prevention in students. Universities may consider establishing policies for addressing EOB-related confidentiality concerns.     

GEOGRAPHICAL PERSPECTIVES ON SAFE MOTHERHOOD IN THE HILL COUNTRY OF SRI LANKA: A CASE STUDY OF THE DORAGALA TEA PLANTATION IN PUSSELLAWA

ABSTRACT

In comparison with other South Asian countries, Sri Lanka maintains well-developed health care systems. Nonetheless, limited health care services are provided to mothers and children in the hill country. This research raises a series of questions concerning current challenges for safe motherhood, such as health care services already present, spatial distribution of health care professionals, and health policy in the hill counties of Sri Lanka. The authors argue that to understand the existing infrastructure of health care systems and future challenges to provision of health care services, it is important to depict the spatial location of health care units and to recognize the complexity of interactions between these units and the social, economic, and health environment. Such assessment provides a human geography approach that investigates health care systems in spatial dimensions. This study uses the geographical techniques of Geographic Information Systems and Global Positioning Systems to answer the fundamental questions of “what is where,” “why is it there,” and “why do we care.” The questions underline the importance of spatial methodology in assessment of safe motherhood and the importance of accurate and precise knowledge about the status of maternal health.     

Risk Management in Online Human Services Practice

SUMMARY

The growing use of the Internet for human service practice has resulted in ethical and legal issues that have yet to be fully addressed by current professional codes of ethics and the courts. This paper describes issues and risk-management procedures related to online human service practice, including: use of novel and untested services, unclear jurisdiction, equivalence of face-to-face and online practice, duty to warn and to provide emergency services, privacy and security of online transactions, establishment of fiduciary relationships, online assessment, and fees for online services. In addition, risk-management issues related to human service agency Web sites including copyright, ownership of the Web site, posting of staff names, online fundraising, online threats and disruption of services, unsolicited e-mail, and agency e-mail policies are discussed.     

Parents: Dilemmas for Professionals

A professional critically examines her practices towards parents whilst an educational psychologist. Aspects of the power relationship are explored, including acting as a friend, the trappings of professionalism, privacy and confidentiality, interprofessional trust, and the provision of services. A tentative conclusion reached is that these create dilemmas which are part of the workings of the system within which the educational psychologist works, and that professional survival is the underlying motive.     

Fossil Fuels and Food Security: Analysis and Recommendations for Community Organizers

ABSTRACT

This paper examines the relationship between fossil fuels and food security and makes recommendations for community organizers. During the 20^th century, North America's food system grew critically dependent on oil and natural gas for production, processing, and transportation. The authors argue that numerous petroleum-related factors including supply problems, increasing global demand, and geopolitical tensions may now threaten food security. Various approaches to reducing fossil-fuel dependency and increasing local food production are explored. The authors conclude that community organizers can make important contributions to local food security, and they provide specific recommendations and resources for doing this.     

Mental Health Recovery

Abstract

Strengths-based approaches that emphasize culturally competent services and naturally occurring community support may be more appropriate than traditional mental health services for African American adults with psychiatric disabilities. An examination of the literature on service utilization and treatment needs for this population highlights the paucity of empirical studies in these areas, while an exploration of the literature related to psychiatric recovery, a prominent strengths-based framework, reveals insufficient application of the approach to the specific interests of African American service recipients. We suggest that recovery is in fact highly compatible with such culturally relevant approaches as the Afrocentric model, and argue that the concept of recovery may therefore provide a resonant and particularly useful framework for practice with this population. Implications for research, practice and policy are discussed.     

Foreign Swamis at Home in India: Transmigration to the Birthplace of Spirituality

Women and men use local experience and experiences gained elsewhere when they embark on migratory projects to reconfigure social space and practices back home. To explore this claim, the authors argue that we must analyze the relationship between mobility and authority, especially how experiences of mobility bestow authority on the moving subjects. This argument is illustrated by an examination of three differently situated narratives from which two interrelated fields of analysis emerge. One field is related to how authority is perceived in relation to control. The other field is related to the kinds of experience that are produced through acts and narrations of movement and how these experiences become articulated to provide authority to individuals. The authors conclude that movement may subvert and / or reproduce authority, just as authority may be both a source and an effect of movement.     

Web-Based Support for Program Planning and Research

Abstract

Recent advances have made a variety of instant communication technologies widely available to human service researchers. The authors describe one such technology, electronic mail networks, and illustrate both its advantages and disadvantages in improving applied research collaboration within the human services.     

Ethical Issues in the Mental Health Treatment of Gender Dysphoric Adolescents

SUMMARY

This paper will focus on ethical dilemmas that arise in the treatment of adolescents with gender dysphoria. We will begin with a discussion of ethical and legal issues pertinent to the treatment of any adolescent, and then proceed to the gender dysphoric adolescent, since there is a great deal of overlap between the two areas. The authors re-view legal decisions, the existing data on adolescent decision-making, and ethical principles that may help the clinician in resolving some very complex situations. Utilizing case vignettes of three gender dysphoric adolescents, the authors provide a pragmatic illustration of the ethical dilemmas involved in evaluation and treatment of these youth. It is the authors' belief that treatment interventions should be based on respect for the adolescent's autonomy and confidentiality where he or she is deemed competent to make decisions.     

Self-Determination and Confidentiality

ABSTRACT

This article seeks to further clarify the ambiguous nature of two of social work's most important values: self-determination and confidentiality. Previous research indicates that many ethical decisions in social work practice are difficult to make; and, many times decisions are made based on the worker's values and experiences rather than on written ethics, laws, and agency policy. To explore this concept further, an open-ended survey instrument was distributed to 82 social work students after completing the required practice classes. The participants were asked whether they would break confidentiality based on a specific vignette and describe what decision was made and why. Results indicated that degree level (MSW versus BSW) proved to be a significant factor related to whether and/or why the respondent would break confidentiality. In addition, students with more paid work experience were more likely to question the issue of confidentiality and were more likely to break it. Two issues reflected in the decision-making process involved ensuring client safety and self-determination. In conclusion, this article explores possible reasons for breaching confidentiality and pitfalls that can occur for all professionals in making these types of decisions. Furthermore, it explores the ambiguous nature of problem solving in this area, and suggests ways that social workers can improve their decision-making skills.     

New Technology and the Human Services

Summary

Much has been written about the effects of new technology on the human services and about its possible implications for agencies, practitioners and service users. There is also an important and expanding literature on the implications of new technology for society as a whole, including much which addresses issues of social justice. Until recently, however, there have been only a few attempts to explore the range of issues specifically concerning the relationship between social justice and the human services. My main purpose here is to start to sketch out the parameters of the field of study relating new technology to social justice in the human services and to explore some of them in depth.

Three examples of different definitions of social justice are introduced, viz.; justice as equity; flexible individualised justice; and empowerment. Then normative and ethical considerations in relation to new technology in the human services are briefly reviewed. In the main body of this paper these issues are brought together in relation to three key areas (i) the manager/professional interface (ii) strategies for new technology implementation-top down or bottom up and (iii) the relationship between social worker and service user. Finally some conclusions are drawn about the possibilities for a synthesis between competing visions of social justice.     

Chapter 10: Ceridian's Experience in the Integration of EAP,Work-Life and Wellness Programs

SUMMARY

This article considers EAP services, work-life and wellness programs and the implications of integrating these services. The concept of how wellness programs enter into this equation is explored as well as how Web-based services have played a significant role. Ceridian's experience in providing these services is explored through a case study, anecdotal information, and other data. This article reviews why integrated EAP services, work-life and wellness programs offer more value when compared to programs that contain individual components. It is concluded that wellness and the Internet continue to play a key role in programs becoming more integrated. It is also suggested that integration is now larger than traditional EAP, work-life, and wellness programs. Other human resource services are becoming more important components of integrated services.     

Snippets and silences: Ethics and reflexivity in narratives of sistering

This paper considers two aspects of feminist orthodoxy regarding ethics and reflexivity during data analysis in qualitative research. These methodological issues surfaced in an exploratory study of how discourses of sistering socially construct and produce feminine subjectivity. Research was carried out with 37 women aged between 6 and 50 from different class and ethnic backgrounds living in the UK. Auto/biographical work in sociology influenced the design of the qualitative methods and the use of a grounded theory and case study approach to the analysis of the interview narratives. The discussion of methodological dilemmas-how to analyse multiple perspectives of relationships with varying degrees of disclosure among participants-is located within both feminist standpoint and poststructuralist theory. A case is made for guaranteeing anonymity rather than confidentiality, and offering selective reciprocity rather than an equal exchange between researcher and participants. The challenge of working with feminist reflexivity is considered through the notion of bounded privacy and a silenced 'I'.     

Complex archetypal structures that underlie the ‘human condition’

Abstract

In this article I synthesise notions from several different fields to argue that there are archetypal structures that underlie the human condition that can best be understood through the language of complexity. In so doing I accommodate the disparity that exists between different branches of the social sciences through the provision of a holistic overview that accords with the idea of a coherent scientific body of knowledge. To do this I use a Jungian typology to reinforce the parameters of four archetypes by which organisation and individuals have been interpreted, and locate this within some findings from evolutionary psychology, thereby building a meta-typology of the human condition. I conclude by suggesting that this can best be understood through the notions of relationship and knowledge through the opposite, and by examining some of the implications this approach holds for the field.