Donate
Donate
DONATE
Donate
Donate

DONATE

Confidentiality Policy

Confidentiality Policy

CONFIDENTIALITY POLICY AND AGREEMENTS

OVERVIEW

Mutual trust and confidence between client and worker are the basics to an effective program of assistance and services.  All information secured by or available to the agency staff shall be the property of the agency and should be used only in compliance with state or federal legislation.  Such information shall not be the subject for casual conversation among the staff or with their families or acquaintances.  Breach of this regulation is not only a violation of state law, but is a direct violation of the Standards of Conduct and can result in dismissal from the agency.

RECORD STORAGE

All information pertaining to client records will be secured on premises of FCSS, Inc.  Client case files are the sole property of this agency and will be kept in a location secured by a locked filing cabinet at the administrative office facilities.  Absolutely no client files will be taken home, to school, or otherwise unless approved prior by a supervisor or the Executive Director.  Breach of this regulation is a direct violation of this agency’s policy and will result in immediate dismissal.

RETENTION OF CASE RECORDS

All client files will be retained for 5 years in the administrative facility.  Older records will be moved to a remote, secured location for as long as space permits.  In the event records must be destroyed, they will be destroyed based on age, and the oldest will be the first to be destroyed.

 EXPECTATIONS OF CONFIDENTIALITY

According to Virginia Code § 63.2-104.1, programs and individuals providing services to victims of sexual and domestic violence are prohibited from:

  • Disclosing any personally identifying information or individual information collected in connection with services requested, utilized, or denied through DV/SA programs.
  • Revealing individual client information without the informed, written, reasonably time-limited consent of the person (or in the case of an unemancipated minor, the minor and the parent or guardian; or in the case of an incapacitated person as defined in § 37.2-1000, the guardian) about whom information is sought, whether for this program or any other Federal, State, tribal, or territorial grant program, except that consent for release may not be given by the abuser of the minor, incapacitated person, or the abuser of the other parent of the minor.

If the release of information is compelled by statutory or court mandate, the service provider shall make reasonable attempts to provide notice to victims affected by the disclosure of information and take steps necessary to protect the privacy and safety of the persons affected by the release of the information.

Programs and individuals providing services to victims of sexual or domestic violence may share:

  • Non-personally identifying data in the aggregate regarding services to their clients and non-personally identifying demographic information in order to comply with Federal, State, tribal, or territorial reporting, evaluation, or data collection requirements
  • Court-generated information and law enforcement generated information contained in secure, governmental registries for protection order enforcement purposes
  • Information necessary for law enforcement and prosecution purposes

CONFIDENTIALITY/CONSUMER PRIVACY

Family Crisis Support Services, Inc. will make every effort to ensure confidentiality and protect consumer privacy of all staff, clients, volunteers, board members, and the general public prior to any information being presented to the public for promotional or marketing purposes.

Prior to the disbursement of any photos, names, videos, or recordings, this form must be completed and a copy retained for as long as the information is used by this agency.

EMPLOYMENT STANDARDS

All employees must maintain complete confidentiality with individual residents.  Any employee or volunteer who reveals resident location to any unauthorized persons will be immediately dismissed.

To be eligible for employment or volunteer services with this agency, all persons must complete the following form and return it to the Executive Director

FAMILY CRISIS SUPPORT SERVICES, INC.

AGREEMENT OF CONFIDENTIALITY

& Receipt of Personnel Policies & Procedures

Between Employee/Board Member/Volunteer & FCSS, Inc.

I, _____________________________________, have read or have had read to me the Personnel Policies & Procedures for Family Crisis Support Services, Inc. I understand that the personnel policies & procedures do not constitute an expressed or implied contract. All employees of Family Crisis Support Services, Inc are employees at will and not for a specified term and are subject to dismissal without cause. I agree to act in accordance with the code of conduct and to comply with the policies & procedures set forth in this document.

As in Virginia Code 63.2-104.1:

Our agency is prohibited from

  1. a) Disclosing any personally identifying information or individual information collected in connection with services requested, utilized, or denied through our domestic and sexual violence services.
  2. b) Revealing individual client information without the informed, written, reasonably time-limited consent of the person (or in the case of an unemancipated minor, the minor and the parent or guardian: or in the case of an incapacitated person, the guardian) about whom information is sought, whether for this program or any other Federal, State, Tribal, or territorial grant program, except that consent for release may not given by the abuser of the minor, incapacitated person, or the abuser of the other parent of the minor.

If the release of information is compelled by statutory or court mandate, the agency shall:

  1. Make reasonable attempts to provide notice to victims affected by the disclosure of information.
  2. Take steps necessary to protect the privacy and safety of the persons affected by the release of the information.

The agency may share

  1. Non-personally identifying data in the aggregate regarding services to their clients and non-personally identifying demographic information to comply with Federal, State, tribal or territorial reporting, evaluation, or data collection requirements.
  2. Court-generated information and law-enforcement generated information contained in secure, governmental registries for protection order enforcement purposes.
  3. Information necessary for law enforcement and prosecution purposes.

 I further agree to uphold the following standards of confidentiality:

* I will not disclose the location of the domestic violence shelter.

* I will not confirm or deny the presence of any resident at the shelters without written permission to release that information.

* I will only discuss the specifics of a resident’s situation and my assessment of the situation with other staff members, volunteers, or board members.

* I will not share information about a resident with other residents that they have requested to be kept confidential or that they have not shared with other residents except when a resident or a child has a communicable disease or parasite (lice, scabies, chicken pox, measles, etc.) that can be spread by casual contact. This exclusion DOES NOT include sharing information that a person is HIV positive, has ARC, AIDS, or any other disease not spread by casual contact.

* I will obtain the consent of a resident or former resident before citing any incident by which he or she could be identified in any form of communication.

* I understand the client files will be kept in a file cabinet in a locked room. Client files may contain the following: Initial assessment, intake form, vadata forms, assailant ID, departure forms, violation report, and release of information, life enhancement tools, and client plan of action/goals. Daily resident/shelter checklist will be filed separately. Residents will only be identified with room number.

* I will keep information pertaining to a resident confidential from outside sources except under the following circumstances:

  • If the resident has given written consent through use of a release of information form.
  • If an identified former resident verbally requests that specific information be released to an attorney or agency that is working on his/her behalf and due to time constraints, a written release is not feasible.
  • If I suspect that there may be child abuse or neglect or adult abuse and neglect and I have discussed this suspicion with the Shelter Manager, the Executive Director, and/or the Chairperson of the Board of Directors to report to CPS or APS.
  • If I suspect that the resident poses a danger to themselves or others and I have discussed this suspicion with the Shelter Manager, Executive Director, or the Chairperson of the Board of Directors.
  • If a release of information is court ordered/subpoenaed and the shelter manager, Executive Director, and/or Chairperson of the Board of Directors is notified.
  • If I am court ordered/subpoenaed to testify and I have done my best to contact the executive director and/or the Chairperson of the Board of Directors.
  • If a resident has a life-threatening medical emergency rendering him or her unable to contact a relative and is unable to communicate with hospital staff, the emergency contact person listed on the FCSS, Inc intake form will be contacted and given the name of the hospital in which the resident is a patient.

I understand that if I violate any of the confidentiality guidelines, it may mean immediate dismissal from my responsibilities and position as a FCSS, Inc employee, volunteer, or Board Member.

I hereby agree to be bound by the provision of the FCSS, Inc. Personnel Policies & Procedures, which supersedes all previous policies and procedures.

_____________________________________________     ______________________________________

Signature of employee, volunteer, or board                        Date

____________________________________________       ______________________________________

Printed Name of employee, volunteer, or                           Signature of Volunteer Coordinator, Executive Director or Board Chairperson

FCSS CLIENT CONFIDENTIALITY GUIDELINES

  1. When you are accessing alternate accommodations, such as a hotel/motel or with family/friends, it is important to keep your location a secret to ensure your safety and the safety of the staff.
  2. If you will be transferring/relocating to one of the shelters during your stay or after you leave, do not reveal the location of the shelters to anyone.
  3. If you are attending a support group, you are to keep the location, date, and time of the meetings a secret to ensure the safety of yourself, other victims attending the group, and the staff and volunteers who facilitate the groups.
  4. The facilities are smoke-free environments at all times.
  5. Names and situations of other victims you meet at the shelters, in support groups, or in court must be kept private.
  6. Everyone who utilizes services or works at FCSS signs a promise of confidentiality.
  7. No matter the extent of services provided to our clients, the details of individual victim’s stories are never discussed outside the agency without the express consent of those victims.
  8. Our agency is prohibited from:
  1. Disclosing any personally identifying information or individual information collected in connection with services requested, utilized, or denied through our domestic and sexual violence services.
  2. Revealing individual client information without the informed, written, reasonably time-limited consent of the person (or in the case of an un-emancipated minor, the minor and the parent or guardian: or in the case of an incapacitated person, the guardian) about whom information is sought, whether for this program or any other Federal, State, Tribal, or territorial grant program, except that consent for release may not given by the abuser of the minor, incapacitated person, or the abuser of the other parent of the minor.
  1. If the release of information is compelled by statutory or court mandate, the agency shall:
  1. Make reasonable attempts to provide notice to victims affected by the disclosure of information.
  2. Take steps necessary to protect the privacy and safety of the persons affected by the release of the information.
  1. The agency may share:
  1. Non-personally identifying data in the aggregate regarding services to their clients and non-personally identifying demographic information in order to comply with Federal, State, tribal or territorial reporting, evaluation, or data collection requirements
  2. Court-generated information and law enforcement generated information contained in secure, governmental registries for protection order enforcement purposes
  3. Information necessary for law enforcement and prosecution purposes. Employees from other agencies, repairmen, and sometimes public donations are scheduled at the shelter.
  1. Residents will be informed of scheduled persons; therefore, residents should be up and dressed by 9:00 A.M.
  2. Also, in an effort to protect the confidentiality of residents from the general public entering the premises for donations, food, etc., the following form must be signed by all visitors upon entry into the facility:

 

 

FAMILY CRISIS SUPPORT SERVICES, INC.

VISITOR SIGN-IN & CONFIDENTIALITY AGREEMENT

I understand the purpose of Family Crisis Support Services, Inc. is to create an environment that is sensitive and responsive to the needs of people who seek their services. As a donor and community contributor, contract laborer, community member, volunteer, and/or state monitor, I respect the agency and their client’s right to privacy.

By my signature on this form, I agree that my presence at and interest in Family Crisis Support Services, Inc. shall remain professional, exclusive of intent to inhibit services, and that anything I witness that is communicated or transpires on site shall remain strictly confidential thus allowing the agency to continue its quality services.

Signature                                                                                           Date

  1. __________________________________________            ___________________
  2. __________________________________________            ___________________
  3. __________________________________________            ___________________
  4. __________________________________________            ___________________
  5. __________________________________________            ___________________

__________________________________________            ___________________

Staff Signature                                                                        Date

 

PROMOTIONAL RELEASE AGREEMENT

Family Crisis Support Services

Program Year ___________

Overview

A major initiative that FCSS, Inc. seeks to promote for all programs during the year is an effort to “tell our story” both to ourselves and to the larger community we serve. This initiative is founded on our strong belief that our Staff/Volunteers are doing great things daily in service to their communities. One of the biggest problems we face is that relatively few people know who we are or what we do. Our goal is to put human faces together with the service of our members and programs so that our performance outcomes are not just numbers, they are lives changed by service.

I, _________________________________________________, SERVING FAMILY CRISIS SUPPORT SERVICES IN THE CAPACITY OF _________________________________________ (title, volunteer, resident, etc), GIVE FCSS, INC., PERMISSION TO TAKE OFFICIAL PHOTOS AND/OR VIDEOS INCLUDING FAMILY MEMBERS, AND TO USE THE PHOTOS SO TAKEN FOR PUBLICITY PURPOSES FOR PROMOTION, COMMUNITY EDUCATION, AND PUBLIC AWARENESS OF THE AGENCY AND THE SERVICES IT PROVIDES. I UNDERSTAND NO ADDRESSES OR PERSONAL INFORMATION WILL BE ASSOCIATED WITH PHOTOS.

BY THIS AUTHORIZATION, I UNDERSTAND AND AGREE THAT NO PARTICIPANT SHALL RECEIVE REMUNERATION AND THAT ALL RIGHTS, TITLE AND INTEREST TO THE PHOTOS AND USE OF THEM BELONGS TO FAMILY CRISIS SUPPORT SERVICES, INC.

I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO INFORM ALL PARTICIPANTS AND THEIR LEGAL GUARDIANS OF THIS AGREEMENT.

THIS AGREEMENT IS IN EFFECT FOR ______________________thru ________________________.

Date __________________           Signature  ________________________________________________

 

CLIENT RIGHTS AND RESPONSIBILITIES

Our program has set up the following rights and responsibilities to clarify expectations and roles and to help keep harmony in the shelter where multiple families and individuals live together and share common spaces. We expect you to keep the common good and others’ safety and comfort in mind while living here.

You have the right to be respected.

You have the right to be treated with respect and without discrimination on the basis of race, gender, ethnicity, religion, sexual orientation, nationality, gender identity or expression, age and/or disability by everyone who lives and works here.

You have the right to be heard. 

  1. We encourage residents to deal with conflicts directly with the people involved whenever possible. If you need help to resolve a conflict, staff is available to problem solve or mediate.
  2. If a conflict with a staff member arises that you feel has not been resolved, you can speak to a supervisor, and if you are not satisfied with this response, you may speak with our executive director. The agency’s grievance policy is given during the intake process and it is also available in the office.
  3. Advocates are available 24 hours a day, 7 days a week. Advocates can help with problem solving, information, referral, and support.  Please note that these hours are subject to change periodically.  Consult an Advocate with any questions you might have.

You have the right to self-determination. 

  1. We are here to support you in making your own decisions. You have the right to manage your finances and set your own goals while you stay here.
  2. Advocates can help you:
  3. Make safety plans for yourself and your children
  4. Clarify your goals while in shelter or transitional housing and create a plan to reach them
  5. Give you information about resources, programs, and your rights
  6. Support you in your parenting
  7. Help you pursue your own priorities

Each family has the right to safety, privacy, and to establish schedules that allow each member adequate rest, peaceful downtime, and time to complete schoolwork and family obligations. 

You are expected to respect the comfort and peace of other residents.

You have the right to be supported in your role as a parent. 

  1. Staff and volunteers of the shelter and transitional programs will ask your permission before caring for your children or providing them food or medicine. We want your children to understand that you, not we, are watching out for them and meeting their needs.
  2. You may make babysitting arrangements with other residents. Please complete a babysitting agreement and give it to staff so that we know who is in charge of your children while you are away.
  3. We want all children to be safe while they are here. Children under 16 must be supervised by a responsible adult. That adult must keep the children within earshot, on the same floor of the building, and be aware of what they are doing.

*Please be aware that children in the program may have been exposed to traumas which result in their acting out, sometimes against other children. For this reason, we ask you to be vigilant in supervising your children.

Every resident, including any accompanying children, has the right to live without the threat of violence.  

  1. Physical and verbal violence are not acceptable in the Shelter or Transitional Programs.
  2. If you are having trouble parenting without using physical force or threats, please talk to your advocate. Your advocate and the children’s advocate can help you create a plan for parenting that is effective and non-violent.
  3. NO WEAPONS ARE ALLOWED IN THE BUILDING. If you need a safe place to store a weapon, please consult with your advocate.

Every resident has the right to a healthy, sober, and drug-free environment.

  1. Some women in our program struggle with chemical dependency issues. We are here to support them in their recovery. Therefore, alcohol and illegal drugs are not permitted on the premises of the shelter.  We ask that you not use drugs or alcohol or be intoxicated on site.
  2. Staff will support recovering residents in a non-judgmental, respectful manner. Please let us know of what kind of support you may need to maintain or reclaim your sobriety and we will do our best to support you.

Every resident has the right to a clean and physically safe environment.

  1. Please maintain your rooms in a manner that is sanitary, safe for children, and considerate of both current and future residents.
  2. Please feel free to utilize personal hygiene items provided.  More personal hygiene supplies can be provided to you upon request.
  3. Please clean up after yourself in the kitchen and bathrooms and do your part to keep the shelter and transitional houses clean.  Together as a group, you will decide among yourselves what chores you are able to do to contribute to the daily cleanliness of the shelter.
  4. Smoking is not allowed inside the shelter or transitional house. Smoking is allowed in the designated smoking area outside.
  5. Please keep your medications locked up in your locker and ensure that no child has access to the bottles or individual pills and to prevent theft.

Every resident has the right to keep their participation in our programs confidential. 

  1. Please do not reveal to anyone who is staying in the shelter or transitional house.
  2. Please be aware of our security system: Alarms, remote cameras, and computer monitoring software.
  3. Please inform the staff of any suspicious cars or people around the properties that you notice. Please call 911 if you observe prowlers or otherwise feel in danger.
  4. We kindly ask that you please provide proof of insurance in order to park your vehicle in a public or hidden location on properties.

You have the right to participate in a program that works for you.  

If the shelter or Permanent Supportive Housing Program does not work for you, your advocate can help you find alternative housing that will better suit your needs.

The shelter and transitional house program may ask you to leave if any of the following occurs:  

  1. Violence or threats of violence towards staff or other residents.
  2. Bringing illegal drugs into the shelter.
  3. Breaking another resident’s confidentiality.
  4. Bringing your abuser to the shelter.

*If you are having trouble with the other responsibilities that relate to communal living, staff will work with you individually and in house-meetings to create a plan that works for you and facilitates harmonious group living.  

I have read or have had read to me the resident rights and responsibilities.  I understand these rights and responsibilities and know that I may ask for clarification at any time.

____________________________________________________                ___________

Resident Signature                                                                                          Date

____________________________________________________                ____________

Employee/Volunteer Signature                                                                      Date
Donate