Taushetsplikt, opplysningsrett og opplysningsplikt
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The purpose of this project is to create new knowledge on how cooperating public service providers implement their rights and duties regarding confidentiality and disclosure. Agencies include the health and welfare services, the police, correctional services, the Child Welfare Services, kindergartens and schools. We have examined whether the practices comply with the rules and regulations, as the authorities have interpreted them in guidelines and informational publications and identified the causes of noncompliance. The main research questions have been: - To what extent do the informants have knowledge of confidentiality and disclosure obligations? - To what extent have guidelines and informational publications contributed to an awareness of the rules? - To what extent is the duty of confidentiality an obstacle for cooperation? - What other potential obstacles to cooperation exist? - If cooperation with other agencies is limited, what are the causes? - Are participants aware of the legal exceptions in exercising the duty of confidentiality? - To which extent do participants obtain consent from involved parties? What challenges in obtaining consent arise in cases involving children and parents? - To what extent is anonymisation used to facilitate collaboration, in which ways and how does it work? - How well known are The Child Welfare Service’s and Social Welfare’s duties to inform, and to what extent is it fulfilled? - To what extent does the Child Welfare Service comply with its duty to give feedback? Design /methodological approach We conducted a literature review, to determine what evidence exists in this field. An analysis of documents was done to study the legal aspects, and specify the normative framework for assessing practice. Four municipalities and a borough of Oslo were selected for this study. Semi structured interviews and a structured survey were carried out with employees in the following sectors: primary health services, somatic and psychiatric specialist health services, public administration, the Child Welfare Services, kindergartens, schools, The Educational and Psychological Counselling Service, the police, correctional services, and the Norwegian Labour and Welfare Service. Three principle findings The rules regarding the duty of confidentiality are generally perceived to be valuable and necessary. All our participants had knowledge of the confidentiality obligation and its implications. Furthermore all participants were aware of the consent and anonymisation exceptions. Therefore these means are used extensively as grounds to share sensitive information. A key response from practitioners in the field is that they do not perceive the rules regarding the duty of confidentiality to be obstacles to cooperation. On the contrary, the informants state that the existing rules, especially the exception rule, are sufficient to communicate essential information between services and agencies. A new approach to cooperation and interaction has been a result of the increased focus on these issues in the latter years. The participants experience that clients or users of their services take part in a different way than before. They express that practice is changing, and that their work is now more client focused. Nonetheless, the participants report that not all necessary information is exchanged, and they want better collaboration between agencies. It remains unclear whether the regulations themselves or other factors determine if information actually gets shared. This is as much a matter of trust between agencies, personal relationships and experiences with previous partners, as it is a lack of acknowledgement of, or capacity to, understand other agencies’ informational needs. A second issue is that the participants rarely read laws, informational publications or guidelines, even if they are insecure about the current rules. The participants report that that they barely know the different guidelines, that they aren’t available at their place of work, or that they are available, but still don’t read them. The different services and agencies vary with regard to training on the duty of confidentiality and cooperation, and which aspects they focus on. There is consistency between the manager’s knowledge of and preoccupation with the regulations, and each employee’s confidence in their knowledge of the regulations. The third major finding is that the rules about exceptions are not well-known. Some of the participants are aware of the exceptions in the laws governing their field of work, but the vast majority have never read the relevant sections of the law. The participants’ knowledge of The Health Personnel Act section 23 no. 4 is especially inadequate. The Public Administration Act section 13b no. 5 and no. 6. are also not well-known to the informants, but they have somewhat better knowledge of the limitations to the duty of confidentiality in the special legislation. The duty to disclose information to the Child Welfare Service is well-known amongst the participants. A large majority state that this duty is fulfilled according to the intentions of the law. The duty to disclose information to other agencies, like the police or welfare services, is less familiar. The Child Welfare Services duty to give feedback to someone who makes a report is well-known by most informants. Although, dissatisfaction is expressed over the lack of feedback from the Child Welfare Service when one self has sent a concern to them. The need for additional knowledge in this field. This project has generated new knowledge in a field where little evidence exists. Our findings have contributed to advancing our understanding of the normative framework experienced impacts actual knowledge, and practice. The field of health and welfare research is dominated by relatively specialized research. There are few cross disciplinary projects involving practitioners and academics. There are many students and employees in these fields of study, and a vast and complicated set of laws and regulations. Many of the students, practically all, are trained in one of the fields that are represented in our study. Many of those practice only one profession. The research is similarly limited to one field. In our opinion the challenges ahead, in the area of health and welfare, are between the various professions, laws and their guidelines. The users of public services need additional evidence across fields and that practitioners can manage both practice and a wider scope of legal understanding. There have been few extensive research programs that have included interdisciplinary and interagency research. One example is a program The Research Council of Norway had for a national action plan on mental health from 2001–2009. Our research project may be seen as a follow up of this research, but with a more limited framework. We do not have knowledge of other studies that have included as many laws and professional fields in the same study. The July 22. 2011 tragedy, has shown the need to improve communication, and practice across services and agencies. While revisions of laws are possible and better coordination of laws, regulations and guidelines continue, we look forward to participating in new inter- and multi disciplinary research projects.Formålet med dette prosjektet har vært å framskaffe mer kunnskap om praktiseringen av taushetsplikten, opplysningsretten og opplysningsplikten mellom samarbeidende tjenester/etater, blant andre helse- og omsorgstjenestene, politiet, kriminalomsorgen, barnevernet, barnehage og skole. Prosjektet har gjennom litteraturstudier, dokumentanalyse, intervjuer og en spørreskjemaundersøkelse generert ny og viktig tverrfaglig kunnskap på et felt med lite forskning fra før.