Maintaining confidentiality, anonymity and trust is not only good practice, it’s vital to delivering a quality NSP service.
Clean needle program (CNP) worker Sue Brownbill, who works as a Hepatitis SA peer educator at Anglicare Elizabeth in South Australia, says that trust is the foundation of the CNP providing clients with a safe and respectful service.
“Trust is a major component of being a CNP worker,” Sue says. “You always have people (clients) looking and listening to what and how you say things, this can put you in a ‘I feel safe’ space or ‘I do not trust this person’, which impacts on the clients in more ways than one.”
Trust and confidentiality are two sides of the same coin in an NSP. To have trust, a person must have a firm belief in the reliability of someone. Confidentiality in this context means keeping personal and health information private and secure (e.g. locked filing cabinets) and not sharing it regardless of who is asking.
NSPs are also an anonymous service. This means that clients do not have to provide their name to receive injecting equipment. Also, the information clients do give cannot be linked back to them.
In a CNP Sue says only basic information is collected, to better inform staff how to respond to trends and a client’s needs.
“We collect date, gender, age, number of syringes provided, number of syringes returned, drug to be injected, number of people this person is collecting for, whether they identify as Aboriginal or Torres Strait Islander origin. [Plus] if applicable, whether they are a new client, referral type, and whether information/education or intensive support is provided,” Sue says.
“People accessing the service trust they are anonymous, not only based on data collected, but also the setup of the CNP space and service delivery,” she notes. “Unless you have the permission of a person who asks if someone comes looking for them, we do not share any information.”
The importance of confidentiality
Sue believes that confidentiality is vital in the client-worker relationship.
“Clients need to know they can access the CNP with the knowledge their personal information will not be shared. This is particularly the case in the CNP as many drug users feel marginalised and most have experienced discrimination or stigma prior to walking into our service,” Sue says.
“Confidentiality deals with the issue of stigma and distrust of health care providers, which can include peer workers in a CNP, at times.”
What happens if confidentiality is broken?
“Mayhem!” says Sue. “The impacts can include a mental health issue or domestic violence which might have the police involved. [The client] might have children taken away, might lose their housing…”
“If a client feels confidentiality is broken, it will deter them from future access of the service and how much they chose to disclose to any other CNP workers in future,” she says.
“This then reduces the capacity to provide harm reduction information and increases the risk of injecting related harms.”
Word also gets out on the grapevine that a service breached confidentiality. This can then affect many other clients’ views of and confidence in the service.
The WA Health NSP guidelines state: “Staff will respect clients’ confidentiality at all times and in all circumstances. Confidentiality must be maintained even when a client is known to be participating in other programs (e.g. pharmacotherapy) or when the client or client’s relatives are known to the provider.”
However, although confidentiality and anonymity are vital to NSPs, it is important to note that this confidentiality can be breached if the safety of a minor is at risk.
The NSW Health NSP guidelines outline this scenario: “NSP workers should be aware that respecting the confidentiality of a child or young person is not sufficient reason against making a report to child protection”.
Trust in the CNP/NSP
Research fellow at the Centre for Social Research in Health at UNSW, Dr Jake Rance, whose research includes looking at trust in NSPs, says trust is essential when talking about decent health care.
“Trust has to be won, has to be maintained and it can be broken,” Jake says. “It’s important within health care generally but within NSPs in particular because it is so easy for those of us who are working in the field to forget that we are dealing with a criminal activity [taking illicit drugs].”
“Trust has particular meaning when you’re dealing with people who are socially and structurally vulnerable,” he says.
Jake believes that NSP workers have the potential to make a powerful difference in the lives of people who inject drugs.
“NSP/CNP staff occupy a unique place in the lives of people who inject drugs. It is a place where their professionalism, (‘accidental therapy’) skills and simple humanity can do so much more than the simple provision of injecting equipment,” Jake says.
“NSP staff are the unsung heroes of harm reduction.”
– Remi Li and Sophie Marcard
Practical tips for maintaining confidentiality and anonymity in the NSP
Myf Briggs, Tasmanian Statewide Coordinator of the Needle and Syringe Program, advises:
- “We have a general rule of thumb to not initiate contact outside of the NSP, but rather let people do the initiating. By initiating contact you may be outing them or placing them in an awkward position.”
- “Don’t talk about one client to another client, not even their partner.”
- “Don’t ask for identifying information or about the client’s drug use in front of other service users.”
- “Don’t use identifying information in worker meetings or with other workers. In meetings, be sure to use de-identified details and talk about scenarios, not specifics. This means that you can’t say ‘the client with tatts and a nose ring’ as that identifies a service user.”
- “Don’t ask a client for their name. And don’t be too curious or prying about their lives or drug use.”
- “Remind clients of your service’s commitment to confidentiality.”
Dr Jake Rance’s tips to help build trust for CNP/NSP workers
- Be genuinely non-judgmental
“Clients can be extremely appreciative of small acts of kindness,” Jake says of NSP clients.
- Be honest in the NSP/CNP
Be honest with people, this includes telling people what they don’t want to hear. “No one wants to be messed around and a little honesty can go a long way,” says Jake. This might be the case with referral to treatment that has a waiting list and the client is keen to start today.
- Give practical assistance
Be helpful where possible, whether it be as simple as charging a phone when asked. “Going the extra little step for someone who uses an NSP can mean a lot,” he says.
- Be aware of the power relationship
“There is a degree of power that NSP/CNP workers have. It is important to be careful and aware of this power relationship,” Jake says.
A confidentiality poster to display in your NSP: