Hold Team Meetings . Monitor and Evaluate Your Efforts . Sustain Your SART . Know Your Team . Critical Issues
Other Confidentiality Issues
Many other issues affect confidentiality. Here is a sampling of issues, with links for more information:
In This Toolkit: Critical Issues: HIPAA
The Health Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects the privacy and security of an individual's health data, particularly regarding the acquisition, use, and exchange of patient information. The rule poses some challenges for SARTs, however, when individuals are not clear on HIPAA exemptions and permissible disclosures.
Confidentiality and Sexual Violence Survivors: A Toolkit for State Coalitions. Discusses the use of interpreters as it relates to confidentiality.
A National Code of Ethics for Interpreters in Health Care. Lists a code of ethics for interpreters in health care, developed by the National Council on Interpreting in Health Care.
Before using an interpreter to translate for victims, be aware of any confidentiality issues that may arise. Also be aware that finding an interpreter unknown to the victim may be a challenge, depending on the size of your jurisdiction. Review any local and state laws, rules, and procedures regarding the use of interpreters in your jurisdiction.
In many states, medical personnel must report to law enforcement and/or social services if they have treated children, elderly persons, or vulnerable adults who have been sexually assaulted.23 On the other hand, laws requiring health care providers to report cases of competent, adult rape victims vary greatly throughout the Nation. Some states specifically require health care providers to report treatment of sexual assault victims to law enforcement, others require health care providers to report nonaccidental or intentional injuries that can include rape, and still others have laws mandating reporting for injuries caused by criminal conduct or violence.
Keep in mind that members in your SART could interpret state reporting statutes differently, depending on their discipline. Resolve any questions about reporting requirements up front by developing reporting protocols or guidelines and by institutionalizing the guidelines with memorandums of understanding or agreement.
In This Toolkit: Advocates
Describes the advocate's role on the SART team in more detail.
Establishing Victim Services Within a Law Enforcement Agency: The Austin Experience. Describes the benefits to both victims and law enforcement officials of incorporating victim assistance staff within law enforcement agencies.
In some jurisdictions, SARTs place advocates at district attorney's offices, law enforcement agencies, or probation and parole departments in addition to community-based advocacy organizations. Where such arrangements exist, it is essential that the government-based agencies have a clear understanding of the different confidentiality and privilege responsibilities that apply to community-based advocates.
Unique confidentiality issues may arise when serving specific victims. For example—
- Victims in educational settings. Maintaining confidentiality on campus can be problematic. Students often live in such close proximity to each other that privacy is short lived. Jurisdictional issues also come into play (federal laws, state laws, school policies), as do several other factors (e.g., age of victim and attacker, relationship between victim and attacker). For more information, read—
- Confidentiality and Sexual Violence Survivors: A Toolkit for State Coalitions.
- Family Educational Right to Privacy Act, 20 U.S.C. § 1232g.
- The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, 20 U.S.C. § 1092(f).
- Campus Sex Crimes Prevention Act, Public Law 106-386, § 160.
- Foley Amendment (to the Campus Sex Crimes Prevention Act).
- Military victims. The Department of Defense offers unrestricted and restricted reporting options to military victims of sexual assault. Victims go through the unrestricted reporting channel when they want medical treatment, counseling, and an official investigation of the case. If a victim wants medical treatment and counseling but does not want the case to be officially investigated (and therefore retains confidentiality), he or she would be able to use the restricted reporting channel. For more information, read—
- Rural victims. To maintain the privacy of rural victims, consider creating protocols for victims needing services regionally to protect their privacy or activation protocols providing guidance on the response to sexual assault when suspects are well known or in trusted positions (e.g., teachers, coaches, clergy, law enforcement officers, doctors). You also could conduct a community needs assessment survey or hold a town meeting, which might bring to light other issues that need to be addressed when developing guidelines to help ensure victim anonymity. For more information, read—
- American Indian victims. For American Indian victims of sexual assault to be afforded protected communications on tribal land, it is helpful to identify elders or native healers who can work confidentially with these victims. Oral history and traditions can still be used to develop and apply concepts of tribal justice. Disclosure itself, especially to multiple professionals, is not always culturally congruent with American Indian values of privacy, the emphasis on spiritual recovery, and the protection of native cultures from further outside intrusion.
American Indian communities that have confidentiality policies within their tribal codes can help ensure that victims are afforded both state statutory and tribal code rights for privileged communications to ensure privacy whether victims receive tribal or non-tribal services.
For more information, read—
- In This Toolkit: American Indian Victims.