Protecting Tenant
Confidentiality in
MHSA Housing
MHSA Housing Program Operations TA Call
Wednesday March 2, 2011
www.csh.org
The purpose of maintaining
tenants’ confidentiality
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Protect tenants’ right to privacy.
Protect tenants from information being
disclosed, which could potentially be
used against them.
Encourage tenants to establish trusting
relationships with staff.
The purpose of maintaining
tenants’ confidentiality
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All staff should facilitate a community that
values and upholds the individual’s right to
privacy by regularly reinforcing the
importance of maintaining one another’s
confidentiality.
However…….
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Information about a tenant should be shared
with other staff members within your
organization if it is required for them to do
their jobs; namely, to protect a tenant’s
safety or to enhance their well-being.
Some Reasons to Share
Client Information
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Improve an agency’s ability to determine how to
work most effectively with the client to achieve
their goals.
Service coordination with other agencies.
Reduce duplication of services.
Avoid asking client for the same information
over and over again.
Evaluate the overall effectiveness of programs.
Monitor services provided and resources used.
How do we define the lines?
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Because there is a great deal of
misconception about what is confidential
information, service staff may appear
withholding or secretive when it comes to
providing information to support staff. This
may frustrate support staff.
It is important for all programs to establish
what is confidential, plus what can be shared
by all levels of staff.
What is confidentiality for
Service Staff?
Based on the Social Work Code of Ethics:
 Social workers should respect the privacy of
clients and hold in confidence all information
obtained in the course of professional service
(sessions, charting, through collateral sources,
etc.).
 Social workers should share with others
confidences revealed by clients without their
consent only for compelling reasons.
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What is confidentiality for
Service Staff?
Based on the Social Work Code of Ethics:
(continued)
 Social workers should inform clients about the
limits of confidentiality in a given situation.
 Social workers should afford clients
reasonable access to any official social work
records concerning them (Freedom of
Information Act).
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What is Privileged
Information?
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For social service staff, only information that is
obtained in the context of professional service
— that means through a counseling session,
through a collateral contact and/or through a
chart — is privileged.
Confidentiality does not apply to information
observed in a public forum, for example, a
tenant who was observed drunk or a tenant
who is disruptive in common area.
What is not considered
confidential?
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Observable, public behavior.
Information obtained not in the course of
professional service (hearsay, casual
conversation).
Exceptions
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Some clear exceptions to tenants’ right to
confidentiality exist within the HIPAA
regulations. According to the HIPAA regulations,
protected health information may be disclosed
without an authorization in specific
circumstances, such as:
Exceptions (continued)
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To protect a child or impaired adult
In an emergency circumstance
To take action on an explicit threat
In response to a court order
For public health activities or purposes
In response to a law enforcement officer’s
request for information for the purpose of
locating a suspect, fugitive, material witness or
missing person, with some limits.
Communication
Also, there are ways in which services can
communicate with property management,
which does not divulge confidential information.
Instead of saying, “The tenant is on 100 mg. of
methadone and seeing a psychiatrist,” it can be
said, “The tenant is receiving treatment, and we
can expect she will stabilize soon.”
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Between the Lines
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What types of information may be shared
across supportive services and property
management teams without violating
confidentiality?
Between the Lines
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Generally, property management staff should
only have information related to an applicant or
tenant's ability to meet the terms of tenancy.
When supportive services staff and property
management staff need to share information,
staff should first obtain the tenant's consent.
Between the Lines
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Supportive housing programs present unique
privacy challenges for the service provider and
the housing provider. Although sharing
information between the two may occasionally
allow for a more informed treatment program,
some information sharing may violate privacy
laws.
Between the Lines
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If a tenant gives the housing provider
permission to reveal the information either to
other tenants or to service providers, the
housing provider should obtain the permission
in writing. Then the housing provider can
inform other tenants or service providers, but
providers should make certain that any
information disclosed is only disclosed to
people the tenant authorized to receive the
information. Additionally, the information staff
disclose should only be the information that the
tenant has authorized to be disclosed.
Between the Lines
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Providers should be particularly careful of privacy
concerns in considering tenant participation
plans, which are required as part of the Mental
Health Services Act Housing Program and other
programs.
Peer counseling should be designed to ensure
that staff and tenants participating in the process
do not inadvertently disclose confidential
information. Providers may want to have tenants
participating in these programs sign
confidentiality waivers and train peer and tenant
counselors regarding disclosures.
Between the Lines
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Case managers should not breach professional
standards and duties by disclosing information
to a housing manager, unless the client
authorizes the disclosure or disclosure is
necessary to protect the health and safety of
others.
Unless waived by the tenant, these
confidentiality obligations apply regardless of
whether the case manager and housing
manager work for the same organization
HIPAA
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Under HIPAA, information regarding a patient‘s
medical care may not be released to other
entities or persons without the patient's
permission.
Additionally, when releasing information with a
patient-approved release, the release must
inform the receiving party that the information is
not to be further disclosed to others.
Although housing providers are not the intended
target of HIPAA, supportive services providers
should ask clients to complete HIPAA release
forms.
Sharing Information during
Tenant Selection
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Generally, a case manager should not disclose
information to the property manager during the
tenant screening process.
Property managers should base screening
primarily on information relevant to the
landlord-tenant relationship, specifically
regarding whether the tenant is capable of
meeting the terms and conditions of residency.
Sharing Information During
Tenancy
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Without an appropriately obtained waiver of
confidentiality, the case manager should not
disclose information to the property manager
during tenancy either.
A property manager is generally not entitled to
request information about the severity and
nature of a client's disability either as part of
an application process or once a tenancy is
established.
Who are we protecting?
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A property manager in possession of such
information may open the door for the tenant to
allege that the property manager made
decisions regarding the tenant’s housing
situation based on this information, which would
be discriminatory. Although the housing
manager may not have considered the
information in making a decision such as the
initial decision to select the tenant or the later
decision to evict, the mere possession of such
information makes such a defense harder to
support.
Sharing Information during
Tenancy
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When serving a special needs population, such
as persons with a mental illness, information
from a case manager may be useful to the
property manager in his or her day-to-day
dealings with the tenant. If the property
manager believes such information would be
useful and in the best interest of the tenant, the
property manager should ask the tenant to
waive confidentiality requirements in writing so
that the case manager may provide the property
manager with the necessary information.
Sharing Information During
Tenancy
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But, again, property managers and case
managers should exercise caution when
making the decision to obtain such
information, since the property manager's
possession of medical information may be
used as evidence of discriminatory treatment.
Between the Lines
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May A Housing Provider Disclose To Other
Tenants That A Tenant Is MHSA- Eligible Or
Resides In An MHSA Unit?
May A Housing Provider Disclose That Certain
Units Are Financed With MHSA Funds?
Between the Lines
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A housing provider should never reveal to other
tenants that a particular tenant has a particular
disability, unless such disclosure is specifically
authorized by the tenant with the disability.
However, this prohibition does not mean that the
provider may not reveal in marketing materials
that the project or some units in the project are
targeted to specific populations or limited by
funding sources to tenancy by a particular group
of disabled persons. Moreover, if one application
is used, applicants are likely to notice questions
that pertain to MHSA eligibility.
Guidelines and Tools for
Sharing Information
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How can Property Management and
Supportive Services staffs share information
without violating tenant confidentiality?
Guidelines and Tools for
Sharing Information
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If a non-support services staff member observes
a tenant’s behavior that he or she believes
indicates a problem or a need for services,
recommended strategies for addressing the
issue include:
Guidelines and Tools for
Sharing Information
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The staff member may offer to introduce the
tenant to a services team member.
If the tenant’s behavior occurs regularly in a
public area, the staff member can ask a member
of the services team to be present to observe
the behavior.
When a non-support staff member shares
information with a services team member,
information about an incident or problem should
be limited to direct observation, not judgments,
hearsay, rumor, or interpretations.
Guidelines and Tools for
Sharing Information
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Property management may report to a services
team member a disruptive episode involving the
tenant that occurred when the team members
were not there.
Tenants who are bothered by other tenants’
behaviors sometimes ask for information about
how other tenants’ issues are being dealt with.
Staff will need to assure tenants that issues are
being addressed without sharing protected
health information. Staff must consistently
express to all tenants what information is
confidential and what is not.
Guidelines and Tools for
Sharing Information
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See Key Principles for Coordinating Property
Management and Supportive Services in
Supportive Housing
Guidelines and Tools for
Sharing Information
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Sample Consent to Release or Obtain
Information Form
Guidelines and Tools for
Sharing Information
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Tenant File Maintenance and Record
Keeping
Guidelines and Tools for
Sharing Information
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Sample Memorandum of Understanding
Between a Nonprofit Housing Developer,
Social Service Agency and Property
Management Agency
Guidelines and Tools for
Sharing Information
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Guidelines for Case Records
For more information, see:
ww.csh.org