One of the major issues generally encountered in youth peer support programs is the disclosure of personal information and related confidentiality issues, i.e. how can program facilitators ensure that disclosed information remains within the program or only between volunteers, particularly once a program has been completed?
Young people are less likely to use a peer support service if the levels of confidentiality are not clearly communicated and they feel unsafe to divulge sensitive information about themselves. Therefore, it is of great importance to have guidelines in place that clearly outline the service’s confidentiality commitment, as well as to adequately train the peer supporters to adhere to these principles. Again, it is crucial that peer supporters have an accessible supervisor to assist with issues that are too complex for them to manage on their own.
Handling sensitive information
How a volunteer deals with the information that has been disclosed to them can also be a reason for concern in the management of peer support services. Insufficient knowledge of a certain topic may lead to the peer volunteer’s inability to provide the necessary support or referral to another service or depending on the severity of the problem volunteers may feel the need to discuss the issue with someone else as they cannot deal with the burden of the relationship on their own.
Another challenge is how to respond if information pertaining to negative behaviour is ‘leaked’ by peers so that the following consequences do not compromise the identity of the messenger.
The importance of regular, accessible and meaningful supervision needs to be stressed – if a qualified supervisor is not available to program participanrts then the program should not go forward. If the Coordinator is the supervsior the time for this should be identified within the PD so as to insure their availability. Group supervision can also be effective when it si carried out issues-based but it must never take the place of individual ongoing supervision.
Key issues encountered in a peer support program targeting youth at risk of mental health problems and suicide were reported to be around the peer supporters’ ability to recognise the severity of a problem a young person was dealing with and that was disclosed to them. Due to lacking knowledge of the issues the peer supporters were not able to respond appropriately and to make referrals to other support systems if these were required.
The issue was overcome by implementing more appropriate training, supervision and ongoing support processes for the peer supporters which aimed at raising their awareness to recognise critical situations in which a young person required further assistance and referral.
Managing confidentiality issues
Recommendations of how to manage confidentiality issues include:
- Asking peer supporters about their understanding of confidentiality, e.g. by brainstorming what the issue means to them, writing all aspects of confidentiality down, and then using this as a basis for what confidentiality means in the circumstances relevant for the peer supporters (see below for an example of a working definition of confidentiality for a peer support service);
- Providing clear guidelines on when confidentiality must be broken and having them in written form available to be consulted by the peer supporters at any time they need guidance in this regard (see below for an example of guidelines); and
- Establishing a standard process as to how peer supporters convey the confidentiality agreement to their service participants, e.g. by putting up visible signs and distributing welcome flyers to participants and volunteers that reiterate how confidential information is supposed to be dealt with. Linked to the issue of having to break confidentiality, this may also include having young people sign confidentiality agreements when signing up for the program, which clarify that sensitive issues can be discussed with the supervisor. The importance of confidentiality may further be emphasised with introducing penalties as consequences of breaching the contract, e.g. resulting in exclusion from the program.1
Confidentiality for a peer support service1
- Everything said to you in your role as a peer supporter should be kept to yourself.
- In supervision/debriefing, speak about the issues raised but do not disclose information that would identify the individual.
- If records are kept, write them immediately and put them in the locked place where they are stored. Do not take them away with you.
- Only identify the individual who has sought your help in the circumstances agreed in your peer support service and then only to the coordinator(s) responsible for the peer support service.
- Always consider your surroundings when having a confidential conversation – who may be able to hear you – should you close the door, move?
- Always consider the security of where records are kept especially if computer based.
You will need to break confidentiality if, at any time, the health or safety of the person seeking your help or any other person is at risk.
Situations in which confidentiality will need to be broken:1
- There is disclosure or evidence of physical, sexual or serious emotional abuse or neglect.
- Suicide is threatened or attempted.
- There is disclosure or evidence of serious self-harm (including drug or alcohol misuse that may be life-threatening).
- There is evidence of serious mental illness.
What to do if confidentiality needs to be broken:1
- Discuss with the person seeking your help the need to break confidentiality and encourage him/her to speak to a responsible adult him/herself.
- Discuss the situation with the adult(s) responsible for the peer support service, preferably with the person’s consent but even if s/he does not consent (with or without the person present)
- The adult(s) responsible for the peer support service will decide what action is needed and who needs to be informed, and they will keep a written record of all action taken.
- You and /or the adult responsible should discuss with the person seeking help any action taken and then continue to support him/her.
- It is important to report the outcome back to the peer supporter when they have needed to break confidentiality and consider the role of debriefing sessions.
- Cowie, H & Wallace, P 2000, ‘Peer Support in Action’, Sage Publications, London, pp.129.