Although it can surely be a challenge, clients being serviced by a team of professionals are nonetheless entitled to a similar degree of confidentiality as their peers that are being serviced by individuals. However, because group care requires a team approach, the team needs to share information in order to be effective. For example, in the case of 24 hour inpatient service, there needs to be an effective communication between and among the shifts to determine if “Jimmy has had a good day.” This contributes to a level of consistency in care, support, and treatment.
Just as in an individual relationship with a counselor, all staff members have a responsibility to breach confidentiality if the client is a danger to self or others. So, if Jimmy is experiencing suicidal ideation, it is only reasonable that the staff that works directly with that specific client be made aware of the situation. Secondly, if we have reason to believe that a child, elderly, or dependent adult has been abused, we should again breach confidentiality as a measure of compliance to mandatory reporting law. In short, the mandatory reporting rules that apply to us as individual clinicians also apply in a group setting.
In my current position, it is generally understood that “anything said to one staff member is said to all.” There are literally no secrets. This policy comes with benefits and limitations. First and foremost, it prevents us from inadvertently breaching confidentiality that was anticipated by our clients. As higher functioning developmentally disabled adults, they have agreed to such policy, and have acknowledged that they understand it. However, I also believe it places limitations on the relationships you are able to effectively build, in part because it pits “staff” against “clients.” There would likely be situations where an individual client would share sensitive information due to the rapport and level of trust with an individual staff member… but that information would not be shared due to the implications of the policy. The end result may be that the trusting relationship between individual staff members and a client is diminished, in part or wholly as a result of that policy.
Another implicit policy is that it is acceptable to disclose information “up” but not “out.” This translates in our ability to share information regarding clients to our supervisors and bosses, but not with other staff that do not regularly interact with the clients themselves. There are, however, situations where information may need to be shared on a need to know basis… for example, when someone picks up a shift, it is probably wise to let them know not to talk about Jimmy’s mom because she just got in a car accident. In any event, information is provided on a need to know basis, where appropriate, with the client’s best interest in mind.
In the end, I agree with and support the policy of “what is shared with one staff is shared with all” because it is conducive to a team environment. While it does place limitations on our ability to leverage individual relationships with clients, the benefits outweigh the limitations. As a result, if I work in a group or a team environment, I would prefer to work in that “everyone knows everything” situation because I believe it’s what’s best for “Jimmy.”