Case Study: Jefferson Parish, Louisiana
Prior to most dispositional hearings, the juvenile probation department (known as the Department of Juvenile Services) in Jefferson Parish, Louisiana produces a comprehensive pre-dispositional investigation report as ordered by Juvenile Court. This report synthesizes social, legal, psychological, and educational histories and assessment information into dispositional recommendations to the court. A youth’s mental health information, including any need for behavioral health services, is an essential component of the report, for determining whether the focus of interventions should be on mental health need and/or criminogenic need to prevent further penetration into the juvenile justice system. The investigating officer in this case was aware that although state law allows access to a wide range of information for the purpose of conducting a pre-dispositional investigation for Juvenile Court, mental health information was protected by HIPAA. Consequently, a consent form to obtain the form was completed according to department procedures.
Upon attempting to gather a mental health history for the adjudicated youth, the investigating officer was told by the local mental health provider that the consent form was not completed correctly. The mental health provider employed a patient records clerk who believed HIPAA consent forms required a witness’s signature. As a result, the mental health history of the pre-dispositional report was not able to be completed until the consent form was approved by the patient records clerk.
In this example, the patient records clerk misunderstood the required elements of a HIPAA-compliant consent form. Through previous work experience, the clerk assumed that a witness’s signature was required in order for the consent form to be properly executed. As a result of this misinformation, vital information regarding the mental health history and future intervention recommendations would have been omitted from the final report, which would potentially have had serious implications for the successful outcomes for the youth and family.
Fortunately, prior to this case, stakeholders in Jefferson Parish, LA – including the Children & Youth Planning Board, Department of Juvenile Services, the Juvenile Court, and the local mental health provider -- realized that there was a lot of misinformation about what was permitted and prohibited by laws such as HIPAA, and other state and federal confidentiality laws. Such misinformation was a major barrier to better planning and coordination for youth who come into contact with the justice system.
To address these barriers, the Children & Youth Planning Board created an Information Sharing Workgroup tasked with developing tools and protocols for juvenile justice information sharing. This workgroup created a catalogue of information sharing laws and a memorandum of understanding (MOU) for juvenile justice information sharing. (The MOU is found at Appendix B of Developing a Juvenile Justice Information Agreement: Process and Pitfalls by John S. Ryals, Jr.) The MOU included a HIPAA and FERPA compliant consent form for use by each of the nine signatory agencies, which included the local mental health provider. This workgroup also identified key elements of consent forms as required by Federal laws. Their work led to the creation of a document that identified specific elements required for consent forms used by various members of the collaborative.
Upon learning of the patient records clerk’s position regarding her perception of HIPAA requirements, the investigating probation officer contacted the Information Sharing Workgroup chairman. The probation officer expressed frustration over trying to obtain information with a valid consent form and the clerk’s refusal to release the requested mental health history. Information gathered for the products described above was used to clarify to the patient records clerk that a witness’s signature was not required by referencing the HIPAA section that listed all the consent form requirements. Upon learning that HIPAA did not require a witness’s signature for consent forms, the information was released to the investigating probation officer for completion of the pre-dispositional investigation report.