I. Introduction

The purpose of this document is to provide guidance in resolving issues related to the confidentiality of patient/client information that are faced by alcohol and other drug agencies, substance abuse treatment providers, and welfare officials charged with implementing State responses to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWA) (Public Law 104-193). These parties confront several issues related to confidentiality as they collaborate in helping their shared clients overcome substance abuse problems that create barriers to the clients’ ability to work.

The Federal alcohol and drug confidentiality law requires covered programs that provide alcohol or drug abuse diagnosis, treatment, or referral for treatment to strictly maintain the confidentiality of substance abuse patient records. This law (42 U.S.C. §290dd-2) and its accompanying regulations (42 CFR Part 2) came about because the U.S. Congress recognized that these safeguards on privacy serve the important purpose of encouraging persons to seek treatment by preventing the disclosure of information related to their substance abuse diagnosis and treatment. (For the full text of the Federal law and regulations, see Appendix A.)

The Federal confidentiality law and regulations have proved to be both remarkably effective and practical in protecting patients from the potential harm of unwarranted disclosures while permitting the release of information in appropriate circumstances. Increasingly, however, the substance abuse treatment field is being called upon to interact and communicate with outside entities, including staff of welfare agencies who are not familiar with these protections

The PRWA has challenged States to help their citizens leave welfare and enter the workforce. In order to do this, States are having to help "harder-to¬serve" welfare clients prepare to enter—and succeed in—the workforce. Among the barriers facing such clients identified in the research are drug and alcohol problems.

Both welfare clients and officials believe that treatment services are important to welfare reform. Providing substance abuse treatment and prevention services can help States meet their welfare reform goals both by moving substance abusing welfare recipients to sobriety/work and by averting inter-generational substance and welfare dependence among young people. As a result, both systems increasingly understand and appreciate the benefits that will accrue from working together effectively.

For a successful collaboration between substance abuse services and welfare systems to occur, both systems must address the implications of the Federal confidentiality law for communication of patient information. How can necessary disclosures be made between the two systems without violating the confidentiality rules?

This document promotes and facilitates compliance with the Federal confidentiality law by both substance abuse and welfare agencies, while permitting communication and linkages between the substance abuse and adult welfare systems essential to successful implementation of welfare reform.

This document was developed for the following audiences:
• staff of State agencies responsible for funding and evaluating substance abuse treatment and prevention programs;
• staff of substance abuse treatment and pre-vention programs, including clinical directors, counselors, nurses and administrative personnel; and
• welfare officials responsible for interacting with welfare recipients with or at risk for substance abuse problems.

The document describes the basic provisions of Federal confidentiality law and outlines the key confidentiality issues pertaining to the substance abuse treatment system and the welfare system. The Federal confidentiality law and regulations are presented in Appendix A; sample patient consent and other forms are presented in Appendix B.

The Federal confidentiality law discussed here applies only to substance abuse patient records and not to records of other health or mental health services. For example, the child welfare system is also undergoing change nationally, but confidenti-ality issues pertaining exclusively to clients within that system are not included in the scope of this guidance.

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