Confidentiality intervention: Effects on collaboration

Research indicates that providing information about mental illness and involving families in the treatment process leads to improved outcomes for persons with severe mental illness (consumers). The goal of the dissertation research was to examine whether confidentiality policies, which specify procedures for releasing information to families, enhance consumer-provider-family collaboration. This question was approached in two ways: first, by examining how confidentiality policies regarding the release of information to families by providers were interpreted and implemented; and second, by examining the effectiveness of a provider intervention that clarifies confidentiality policies. Using a quasi-experimental design, the intervention was introduced into one agency and compared with a second agency that received no intervention. The effectiveness of the intervention was assessed by measuring collaboration as reported by 58 families and 52 providers. As expected, differences were found between providers regarding who initiated the consent process, the types of information that are confidential, and how confidentiality policies were implemented. Similarly, inconsistencies were found among families in their understanding of who should initiate the consent process, the types of information that require consent, and whether their consumer relative was asked for their permission (verbally or in writing) to release information to them. These inconsistencies were found to be barriers to collaboration, thus providing additional support for an intervention similar to the one tested. Although low provider fidelity limited the extent to which the effectiveness of the intervention could be assessed, a pattern of significance was found within the family sample. Families associated with providers that had higher fidelity scores were significantly more likely to receive more information, a greater array of information, and were more likely to be satisfied with provider contact. Although the findings did not reach significance for the provider sample, providers with higher fidelity scores were also more likely to have increased contact with families. While the findings are not definitive, the results suggest that the model intervention is an essential first step in enhancing collaboration. Further research of the effectiveness of the intervention is needed. Low fidelity of the intervention has implications for intervention research and the implementation of clinical guidelines