Challenges into Opportunities: Using Confidentiality and Mandated Reporting to Build Engagement

We know we need to create strong engagement with families and individual family members in order for wraparound to work. The promise of wraparound is predicated on engagement, and the potential for engagement is centered on the relationships build between family members and wrap staff.

One thing we do to varying degrees across the mental health field is promise our clients confidentiality. You can tell me – I won’t spread it around. We need families to trust us with their truth so we can help them help themselves.

But half a second after we offer confidentiality as one part of building that trust, we have to add conditions. “Unless you are going to hurt yourself or someone else.” “Unless I suspect child abuse or neglect.” The truth is, confidentiality isn’t as absolute as we like to present it.

Knowing this, we are faced with three options. The first is to neglect to cover mandatory reporting, and risk destroying any relationship you might have built when the other person knows you aren’t mentioning it (this isn’t usually their first stop in the system) or when it comes up later. This is dishonest, and it almost always comes back to bite you. The second is to throw all the information out there in stark terms, and then move on. This option is better than lying by omission, but it still can be very damaging to engagement.

The third option is the wraparound way.  We take the time to explain confidentiality, including its limits. In that explanation, we specifically talk about how we would handle any mandatory reporting situations, with an emphasis on partnering with the individual/family. Here is an example:

Jared and his 13 year old daughter Tracy were referred to wraparound.  Jane, their wraparound facilitator, shows up to their first meeting. She welcomes them to the program, listens to their hopes and concerns, and explains what wraparound is in terms of those hopes and concerns. After answering a few questions, Jane tells them that everything they tell her is confidential. Only the wraparound team and some affiliated agencies will have access to it.

Tracy says her school councilor said the same thing last year, and then told on her when she said she was thinking about cutting herself. Jane says that safety is different, and she would have to have passed that information on as well. However, she would have discussed how to do so with Jared and Tracy before she told anyone. She takes a minute to lay out how she would have helped Tracy tell someone who could help her, not just have “gone behind her back” and reported her. She tells Jared that the same applies to him. If something comes up that she has to report, she would go to Jared first and help him report himself. She says that no matter what, she is on their team.

You can see how this approach can actually help build the trust in your relationship, rather than threaten it. When you use openness, honesty, and genuineness from the very beginning of the process, the resulting engagement is stronger, and stands up better during tough times.

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