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Chapter 8

Working as a Team

Power-Shifting and Power-Sharing

Because LEAD is built on a framework of voluntary, multi-agency collaboration towards a common goal, it is essential to build and maintain true consensus as the hallmark of a LEAD initiative. Finding common ground among historically autonomous or skeptical partners requires determination and persistent commitment; it takes time and it’s often difficult, but by going the long way around, problems are discovered that could have imploded the effort had it been rushed. Solutions are found by sustaining frank dialogue that sets the stage for ongoing collaboration.

At the same time, It is also important to recognize and redress the innate power differential among members of the PCG, OWG, and CLT (if one has been convened). Thus, all partners must work to maximize the legitimacy and the value of members’ diverse experiences and expertise, avoid tokenism, and understand stakeholders’ often difficult and painful experiences with institutional authorities and gatekeepers. To this end, many LEAD sites provide cross-training opportunities, relationship-building, and community-led forums to support community engagement and power-sharing. Every partner has legitimate needs and frustrations, and acknowledging that frequently is important even for institutional partners to stay at the table and sincerely commit to the process.

This is a Core Principle

Confidentiality and Privacy Regulations

As a collective impact, multi-agency effort, LEAD is built on a foundation of shared information among historically unlikely partners. Multidisciplinary case coordination requires that LEAD’s operational partners – including police officers, prosecutors, case managers, health agencies, and other direct-service providers – share sensitive information.

But when it comes to sharing sensitive information through the use of a multi-party ROI, it is common for LEAD sites to struggle a bit in both theory and practice. Typically, many of the agencies central to LEAD are accustomed to carefully protecting access to the information they gather. Many stakeholders may believe that sharing such information is prohibited by law; others may feel that sharing sensitive information about LEAD participants risks causing them harm.

What is an ROI?

A Multi-Party Release of Information (ROI) sets the terms by which partner agencies may share participant information with one another. Using clear and accessible language, the ROI should name all of the agencies authorized to receive information and explain what kind of information will be shared, who will have access to it, and why this is necessary. The ROI authorizes case managers to share confidential or sensitive information, including but not limited to protected health information (PHI), with other partners, to foster care coordination and legal system coordination that benefits the participant.


The purpose of an ROI

The use of multi-party ROIs enhances care coordination and supports participant progress by ensuring that police and prosecutors have better information about a participant’s situation before they make discretionary decisions that could unintentionally impede someone’s recovery path. Using a multi-party ROI reduces the number of forms a participant is asked to sign, increases ready access to services, and advances a seamless web of care.

Through the proper use of information that can be properly shared, entities that sit in very different postures build trust in one another and make decisions consistent with the collective intent.

Implementing an ROI

Along with completing an initial intake, signing an ROI is one of the two elements required for a person to enroll in LEAD. Each site should ensure that their ROI forms comply with local, state, and federal laws. Sites should also ensure that case managers and other client-facing staff are trained in the purposes and use of the ROI, what it protects, and how to explain the ROI to participants to ensure they understand what they are signing.

ROIs do not require the sharing of specific pieces of information

It should be noted, that while the ROI allows information-sharing, it does not require the sharing of any particular piece of information. Case managers must be skillful in conveying the essential truth of a participant’s situation, without unnecessarily sharing embarrassing information or information that law enforcement officials would feel compelled to take action on. Case managers are always truthful and do not create a false impression that things are going well when they are not, but they often do not share all the information they have because it is not necessary to care coordination.

ROIs do not grant unlimited permissions

So it’s important to remember that multi-party ROIs do not grant unlimited permissions. They must be used only to advance coordination and alignment in order to support participant success.

Participants may revoke the ROI

Under unusual circumstances, participants may, and should, be advised by defense counsel to revoke the ROI, because they face serious risk of investigation or prosecution on serious charges, and it would be unreasonable to take the risk of case manager information-sharing with law enforcement agencies under such circumstances. This is one reason that public defense awareness of how LEAD operates is an important safeguard.

Many people may fear that sharing information this way violates federal privacy laws, such as HIPAA and the Code of Federal Regulations 42, Part 2 (42 CFR, Part 2). In fact, even though 42 CFR, Part 2 is more restrictive than HIPAA, it nonetheless explicitly permits care providers to share information with other entities for the purposes of care coordination with the participants’ permission.

This is a Core Principle

Appropriate Use of Information

Given the sensitive nature of the matters addressed by LEAD – illegal conduct, involvement with the criminal legal system, and protected health information, including psychological and medical conditions – it is very important that partners share information appropriately and respectfully – without causing harm and without discouraging future information-sharing. It’s important for sites to intentionally define their collective intent in sharing information and to cultivate a culture of its appropriate use.

The fact that a multi-party ROI allows people to share information doesn’t mean people should share every kind of information in every circumstance. Any sharing should be purposeful and intentional, and carefully thought through.

Over time, this becomes almost second nature among partners in a healthy LEAD ecosystem, but at the outset, this takes practice, vocalization, and constant reinforcement from the project manager.

Sharing information may feel challenging for some stakeholders

Even with the use of an ROI, the idea that police officers, prosecutors, and case managers regularly share information about the behavior and challenges of LEAD participants may feel both alien and alarming for many stakeholders.

Law enforcement agencies, prosecutors, and jails may more readily adapt to the idea of sharing certain information with other partners; much of the administrative data they gather is generally considered public information, and they are not bound by either HIPAA or 42 CFR, Part 2, though they likely are governing by state and federal information-release restrictions for certain data categories. But for many other entities central to LEAD – such as public health agencies, treatment providers, public defenders, and nonprofit service agencies – the idea of sharing participant information with other entities may be contrary to longstanding practices.

Some partners may find the idea of sharing information especially alarming: prosecutors and public defenders, for example, operate within an adversarial structure. To take another example, case managers may be aware of participants’ unlawful conduct, and sharing that specific information with law enforcement officers could increase difficulties for officers, case managers, and participants alike if officers have enforcement obligations under governing law or department policy.

Examples of how to navigate information sharing

Information must not harm participants, partners, or the project.

  • Case managers should not share specific, actionable data about misconduct or illegal acts that would put prosecutors or police in a difficult position if they take no action.
  • Similarly, law enforcement and prosecutors must not take adverse action against a participant based directly or indirectly on information obtained in the course of LEAD collaboration, except under exceptional circumstances involving an extreme threat to life or safety. Otherwise, nothing will be shared.
  • That said, case managers can’t leave a misimpression that all is well when it isn’t, neither through overtly misleading statements (“He’s doing great!”), nor through omission/silence. Instead, case managers should be encouraged to maintain appropriate limits. If there is nothing helpful to say, “I don’t have anything helpful to share right now” is perfectly appropriate, and it doesn’t create a misleading impression.